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Gallbladder Surgery

The gallbladder is a small organ located beneath the liver that plays a vital role in the digestive process by storing and concentrating bile, which helps digest fats. However, various conditions can affect the gallbladder, leading to the need for surgical intervention.

Gallstones are hardened deposits of digestive fluid that can form in the gallbladder. They can vary in size and number and are a common reason for gallbladder surgery.

  • Causes: Gallstones can develop when there is an imbalance in the substances that make up bile. Factors contributing to this imbalance include excess cholesterol, excess bilirubin, and a concentration of bile due to an emptying dysfunction of the gallbladder.
  • Symptoms: Many people with gallstones do not exhibit symptoms. However, when symptoms occur, they can include sudden and intense pain in the upper right abdomen, pain between the shoulder blades, nausea, vomiting, and jaundice if a gallstone blocks the bile ducts.
  • Risk Factors: Risk factors for developing gallstones include being female, over the age of 40, pregnancy, obesity, a high-fat diet, rapid weight loss, diabetes, and a family history of gallstones.
  • Treatment Options: When gallstones cause symptoms or complications, the most common treatment is cholecystectomy, the surgical removal of the gallbladder. This can be performed using laparoscopic (minimally invasive) or open surgery techniques. In some cases, medications to dissolve gallstones or procedures to break them up might be considered, but these are less common.

Cholecystitis is the inflammation of the gallbladder, often caused by gallstones blocking the cystic duct, leading to a build-up of bile.

  • Causes: The most common cause of cholecystitis is gallstones. Other causes include bile duct problems, tumors, serious illnesses, or infections.
  • Symptoms: Symptoms of cholecystitis include severe pain in the upper right or centre of the abdomen, pain that spreads to the right shoulder or back, tenderness over the abdomen when touched, nausea, vomiting, fever, and jaundice.
  • Risk Factors: Risk factors include having gallstones, being female, older age, obesity, pregnancy, rapid weight loss, and certain medical conditions such as diabetes.
  • Treatment Options: Treatment for cholecystitis often involves hospitalisation, antibiotics to treat infection, and fasting to rest the gallbladder. Surgery to remove the gallbladder (cholecystectomy) is usually recommended once the acute inflammation is controlled.

Gallbladder cancer is a rare but serious condition that begins in the gallbladder. Early detection is challenging because symptoms often appear in later stages.

  • Causes: The exact cause of gallbladder cancer is unknown, but it involves the mutation of healthy cells in the gallbladder, which grow uncontrollably to form a tumour. Chronic inflammation of the gallbladder, such as from gallstones, is thought to increase the risk.
  • Symptoms: Symptoms of gallbladder cancer can include abdominal pain, particularly in the upper right portion of the abdomen, bloating, fever, loss of appetite, unexplained weight loss, and jaundice.
  • Risk Factors: Risk factors for gallbladder cancer include gallstones, chronic gallbladder inflammation, older age, female gender, obesity, and certain hereditary conditions.
  • Treatment Options: Treatment depends on the stage of cancer and may include surgery to remove the gallbladder, surrounding tissue, and lymph nodes. Additional treatments such as chemotherapy and radiation therapy may be used to target cancer cells. Early-stage cancer confined to the gallbladder has a better prognosis and may be treated effectively with surgery alone.

Biliary dyskinesia is a functional gallbladder disorder where the gallbladder does not empty bile properly, leading to abdominal pain without the presence of gallstones.

  • Causes: The exact cause of biliary dyskinesia is not well understood, but it is thought to involve issues with the gallbladder’s motility or the sphincter of Oddi, which regulates bile flow.
  • Symptoms: Symptoms include upper right abdominal pain, nausea, vomiting, bloating, and intolerance to fatty foods.
  • Risk Factors: Risk factors are similar to those for gallstones and cholecystitis, including female gender, middle age, obesity, and rapid weight loss.
  • Treatment Options: The primary treatment for biliary dyskinesia is cholecystectomy. The diagnosis is typically confirmed through tests such as a HIDA scan, which assesses gallbladder function.

Gallbladder polyps are growths or lesions that protrude from the lining of the gallbladder. Most polyps are benign, but some can be cancerous or have the potential to become cancerous.

  • Causes: The exact cause of gallbladder polyps is not clear, but they are often found incidentally during imaging studies for other conditions.
  • Symptoms: Most gallbladder polyps do not cause symptoms. When symptoms do occur, they can include upper right abdominal pain, nausea, and vomiting, similar to gallstones.
  • Risk Factors: Risk factors for gallbladder polyps include older age, obesity, and the presence of gallstones.
  • Treatment Options: Small, asymptomatic polyps may be monitored with regular ultrasound exams. If polyps are large, symptomatic, or show signs of potential malignancy, cholecystectomy is recommended to remove the gallbladder and prevent possible cancer development.

Choledocholithiasis occurs when gallstones migrate from the gallbladder into the common bile duct, leading to blockages that can cause serious complications.

  • Causes: This condition is usually caused by gallstones formed in the gallbladder that move into the bile ducts. Other causes can include bile duct strictures, infections, or tumours.
  • Symptoms: Symptoms include severe abdominal pain, jaundice, fever, chills, nausea, and vomiting. If left untreated, it can lead to serious complications such as pancreatitis or cholangitis (infection of the bile ducts).
  • Risk Factors: Risk factors include having gallstones, older age, female gender, obesity, rapid weight loss, and certain medical conditions such as cirrhosis or blood disorders.
  • Treatment Options: Treatment often involves endoscopic retrograde cholangiopancreatography (ERCP) to remove the stones from the bile ducts. Following ERCP, a cholecystectomy may be performed to prevent recurrence.

Chronic gallbladder disease, also known as chronic cholecystitis, is characterised by repeated or prolonged inflammation of the gallbladder, often due to recurrent gallstone attacks.

  • Causes: Chronic gallbladder disease is usually caused by repeated episodes of acute cholecystitis, leading to thickening and scarring of the gallbladder wall.
  • Symptoms: Symptoms include persistent or recurrent right upper abdominal pain, nausea, vomiting, and intolerance to fatty foods. The pain may be less severe but more prolonged than in acute cholecystitis.
  • Risk Factors: Risk factors are similar to those for gallstones and acute cholecystitis, including obesity, multiple pregnancies, rapid weight loss, and chronic conditions such as diabetes.
  • Treatment Options: The primary treatment for chronic gallbladder disease is cholecystectomy. This can alleviate symptoms and prevent further complications associated with chronic inflammation and scarring of the gallbladder.

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