Located under and attached to the liver, the gallbladder serves as a reservoir

for bile. As it is produced by the liver, bile passes to the gallbladder through a
small tube called the cystic duct. The gallbladder’s muscular walls absorb
excess water and, when stimulated, contract to squirt concentrated bile
through the biliary ducts and into the small intestine, where it aids in
digestion.

Gallbladder
Gallbladder, muscular organ that serves as a reservoir for bile, present in most
vertebrates. In humans, it is a pear-shaped membranous sac on the undersurface of the
right lobe of the liver just below the lower ribs. It is generally about 7.5 cm (about 3 in)
long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity varying from 1 to
1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend
backward, upward, and to the left. The wide end (fundus) points downward and forward,
sometimes extending slightly beyond the edge of the liver. Structurally, the gallbladder
consists of an outer peritoneal coat (tunica serosa); a middle coat of fibrous tissue and
unstriped muscle (tunica muscularis); and an inner mucous membrane coat (tunica
mucosa).

The function of the gallbladder is to store bile, secreted by the liver and transmitted from
that organ via the cystic and hepatic ducts, until it is needed in the digestive process. The
gallbladder, when functioning normally, releases bile through the biliary ducts into the
duodenum to aid digestion by promoting peristalsis and absorption, preventing
putrefaction, and emulsifying fat. See Digestive System.
The major disorder associated with the gallbladder is the presence of gallstones, varying
in shape and size from a pea to a small pear. Accreted from the constituent salts in the
bile, they are most common in diabetic patients, in blacks, and in women; their presence
increases with age. Two of the reasons for the growth of gallstones are believed to be the
presence of excessive amounts of substances such as calcium and cholesterol in the bile
and the retention of bile in the gallbladder for a long period of time. The usual treatment
for gallstones is surgical removal. Two naturally occurring bile salts, chenodeoxycholic
acid and ursodeoxycholic acid, taken orally dissolve gallstones in some patients.
Ultrasound (see Ultrasonics) treatment to shatter the stones also eliminates the need for
surgery in some cases.

Another common disorder of the gallbladder is cholecystitis, or inflammation of the

organ, which is believed to be a result of the presence of highly concentrated bile.
Chronic cholecystitis is sometimes aggravated by bacterial infection, leading to
perforation and peritonitis. Less common is the growth of malignant tumors, which are
associated with gallstones and constitute about 3 percent of all cancer in humans.

Bile, bitter, neutral, or slightly alkaline fluid secreted by the liver and passed
through a duct into the gallbladder, where it is stored and, as necessary,
released into the duodenum. As formed in the liver, bile is a thin, watery fluid
to which the gallbladder adds a mucous secretion, forming a complex
thickened and stringy substance consisting of salts and bile salts, proteins,
cholesterol, hormones, and enzymes. The gallbladder returns water
containing salts and other materials to the circulation and concentrates the
complex further by a tenfold reduction of the bile salts, which the liver
synthesizes from cholesterol. Such foods as fats, egg yolk, and foods rich in
cholesterol cause concentrated bile, together with secretions from the
pancreas, to be discharged into the duodenum to promote digestion, to
stimulate peristalsis and absorption, and to carry off excess cholesterol and
the disintegration products of overage red blood cells. The hemoglobin of
such disintegrating cells degrades rapidly into reddish-yellow bilirubin,
predominant in the bile of carnivorous and omnivorous animals, and
biliverdin, a green pigment that appears in the bile of herbivores. Under
normal conditions, the liver efficiently clears these pigments.

Certain conditions create an inability to excrete bile, and this may create
serious disabilities, such as jaundice. In obese and immobilized persons, in
pregnant women, and in cases of obstruction of flow of bile, gallstones may
be formed by precipitation of bilirubin in combination with calcium and
cholesterol. Stasis frequently coexists with inflammation and infection of the
gallbladder; this may alter the concentration of bile constituents and create
debris around which bile and its components may precipitate to form
gallstones, which may then block the common bile duct to reduce or stop the
flow of bile. Inflammation and infection, together with the consequent
regurgitation of bile into the liver, may damage that organ, sometimes
causing cirrhosis.

CHOLELITHIASIS
Gallstones are solid particles that form within the gallbladder. Gallstones form from a liquid
substance called bile.

Bile is mostly made up of water, salts, cholesterol, and lecithin. The liver makes bile and the
gallbladder is the organ that stores it for later use. During digestion, bile is secreted into the small
intestine to help with the breakdown of fat.

Gallstones

© 2008 Nucleus Medical Art, Inc.

If the concentration of bile changes, particles can precipitate out of the liquid bile, forming solids
called gallstones within the gallbladder. Gallstones are most often made up of cholesterol particles in
85% of the cases.

Gallstones often go unnoticed, but sometimes they can turn into potentially serious conditions that
may require care from your doctor.

Gallstones are the most common cause of gastrointestinal complications in the United States—
approximately 15 to 20 million people are affected by them.

They occur more often in women than men. Roughly 20% of females and 5% of males develop
cholelithiasis. Symptomatic gallstones occur more often in pregnant women. Roughly 500,000
surgeries to remove the gallbladder ( cholecystectomy ) are performed each year in the US.

Risk factors for cholelithiasis

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop cholelithiasis (or gallstones ) with or without the risk factors listed below.
However, the more risk factors you have, the greater your likelihood of developing gallstones. If you
have a number of risk factors, ask your healthcare provider about what you can do to reduce your
risk.

Risk factors include:

Gender
 Women tend to get gallstones more frequently than men due to their higher estrogen levels.

Oral Estrogen Use

In addition, women who take oral contraceptives or postmenopausal hormone replacement therapy
seem to have a higher risk of gallstones due to the estrogen these therapies contain.

Pregnancy

Pregnancy also increases estrogen levels, thereby increasing risk of gallstones.

Increasing Age

As you get older, usually 40 and over, your risk of gallstones increases.

Obesity and Diet

Having mainly abdominal fat appears to raise your risk of getting gallstones. Being even moderately
overweight increases cholesterol in your bile, which may easily form gallstones.

In addition, rapid weight loss or fluctuating weight can increase your risk because low-calorie diets
cause the gallbladder to contract less. People who have had gastric-bypass surgery to lose weight
quickly also have an increased risk for gallstones.

Lack of Physical Activity

Lack of exercise is associated with a higher risk of developing gallstones, perhaps because the
gallbladder is contracting less.

Family History of Gallstones

Like many other conditions, gallstones tend to run in families.

Ethnicity

Native Americans, Hispanic, and those of northern European descent develop gallstones more
frequently than any other ethnicity in the United States. Gallstones occur less frequently among
Asians and African-Americans.

Diseases of the Small Intestines

Diseases associated with gallstones include:

 Crohn’s disease

 Diabetes

 Sickle cell anemia

 Major trauma

 Paralysis

Need for Long-term Intravenous Nutrition (Total Parenteral Nutrition)

 When it is necessary to provide nutrition through the veins, therefore bypassing the intestines, the
gallbladder is less stimulated since there is no food going through the intestines. This increases your
risk of gallstones.

Medications

Certain drugs are associated with an increased risk of developing gallstones, including:

 Fibrates

 Octreotide

 Somastatin

 Ceftraxone

Symptoms of Cholelithiasis

Most people (80%) do not have any symptoms when gallstones are present in the gallbladder
(which is also called cholelithiasis). However, when gallstones grow large, they can travel to and
block narrow passages (ducts) meant only for liquid bile (this is called choledocholithiasis). When
this happens, abdominal pain is usually the most common symptom. It can be constant pain or pain
that comes and goes, especially after meals. Other commonly associated symptoms include
intolerance to fatty meals, bloating, belching, and indigestion.

The cystic duct drains bile from the gallbladder. The hepatic duct drains bile from the liver. The
hepatic duct and cystic duct join to form the common bile duct which carries bile to the small
intestine. When gallstones block these ducts, they may lead to the following more serious
conditions:

Biliary colic—right upper quadrant pain and cramping due to the gallstone blocking the cystic duct

Acute cholecystitis—inflammation of the gallbladder that occurs if the gallstone gets lodged in the
cystic duct without passing into the common bile duct

Cholangitis—a serious infection and a medical emergency that can result if the common bile duct
remains blocked by a gallstone, allowing bacteria to be trapped

Pancreatitis—inflammation of the pancreas that occurs as a result of gallstones blocking the lower
part of the common bile duct

These conditions are likely to cause some of the following symptoms:

 Abdominal pain (usually recurrent right upper quadrant pain, especially in response to fatty foods)

 Nausea and vomiting

 Jaundice

 Fever

 Heartburn

 Excess gas or flatus

 Clay-colored stools
 If you experience any of these symptoms do not assume it is due to gallstones. These symptoms
may be caused by other health conditions. If you experience any one of them, see your doctor.

Diagnosis

Imaging Studies

Abdominal ultrasound—Sound waves are used to produce an image of the gallbladder. This is
usually the best test for diagnosing cholelithiasis, or gallstones .

Abdominal x-ray—Pictures of the gallbladder are produced, and some gallstones can be identified
this way.

Abdominal computed tomography (CT) scan—X-ray images are taken from many different
angles, and a computer puts them together to form an image of the gallbladder.

Hepatobiliary (HIDA) scan—A radioactive dye is injected into the arm, and pictures are then
taken of the gallbladder to determine if it is functioning properly.

Endoscopic retrograde cholangiopancreatography (ERCP)—After you are sedated, a small

tube (endoscope) is inserted through the mouth past the stomach and into the small intestine
(duodenum). A contrast solution is then injected into the bile ducts and gallbladder. X-rays are
taken, which can identify gallstones, tumors, or narrowing in the bile ducts.

Blood Tests

Liver Function Tests—Certain blood tests may help doctors evaluate whether the liver and
pancreas are functioning properly, and if your symptoms are caused by a condition other than
gallstones. These blood tests may include:

 Bilirubin

 Aspartate aminotransferase (AST)

 Alanine aminotransferase (ALT)

 Alkaline phosphatase (AP)

 Gamma glutamyl transpeptidase (GGT)

 Amylase

 Lipase

Treatments

Gallstones that do not cause any symptoms may be simply ignored until they begin to cause
symptoms. However, treatment may be needed for gallstones that cause significant and recurrent
pain. Talk with your doctor about the best treatment plan for you.

Treatment options include the following:

Surgery : Removal of the gallbladder, or cholecystectomy , is usually needed to treat symptoms
associated with gallstones. It is a relatively safe procedure that does not cause any nutritional
problems. It is also not usually necessary to follow a special diet after the gallbladder is removed.

Extracorporeal Shock Wave Lithotripsy : Sound waves can be used to break up gallstones.
Once broken up into smaller pieces, gallstones can pass into the small intestine. Also, smaller
stones are easier to treat with oral bile salt therapy. Because the gallbladder is still present,
however, gallstones are likely to recur after this therapy.

Oral Bile Salts : If surgery is not desirable, bile salts to dissolve gallstones can be taken by mouth.
However, it may take a long time to dissolve the gallstones, and because the gallbladder is still
present, gallstones may recur.

Reducing your Risk of Cholelithiasis

While it is not possible to control certain risk factors, such as gender and ethnicity, you

can take some steps to help reduce your chances of getting cholelithiasis (or gallstones ).

• Maintain or obtain a desirable body weight.

• Do not attempt rapid weight loss.

• Remain or become more physically active.

• Consider avoiding oral contraceptives and hormone replacement therapy,

especially if you have had gallstones in the past.

Maintain or Obtain a Desirable Body Weight

Being overweight increases cholesterol in your bile, reduces bile salts, and makes the

gallbladder contract less. All of these things result in an increased risk of gallstones.

Therefore, achieving a desirable body weight will reduce your risk of gallstones.

Do Not Attempt Rapid Weight Loss

If you are overweight and want to achieve a more desirable body weight, do not lose

weight too quickly. A weight loss of one or two pounds per week is recommended. If

weight is lost more quickly than this, your risk of developing gallstones increases.

Remain or Become More Physically Active

Physical activity is an important part of weight loss and maintenance. In addition, exercise

may help the gallbladder contract, which may decrease your risk of developing

gallstones.

Consider Avoiding Oral Estrogen Pills

Since estrogen tends to increase your risk of developing gallstones, it might be beneficial

to avoid oral contraceptive agents that contain estrogen. Consider other alternative birth

control options if necessary. In addition, postmenopausal hormone replacement therapy

contains estrogen. Of course, there are other reasons hormone replacement therapy may

be harmful as well. Discuss these issues thoroughly with your doctor.