Gallbladder
The gallbladder is a small, pear-shaped organ that plays a crucial role in the digestive system by storing and concentrating bile produced by the liver. Bile aids in breaking down fats and neutralizing acids in food, facilitating digestion as it is released into the small intestine when food enters. However, the gallbladder can be prone to various disorders, most notably gallstones, which can form when there is an imbalance in bile composition. These stones can range in size and may lead to painful symptoms or complications if they block bile flow. Risk factors for gallstones include gender, age, obesity, rapid weight loss, and a family history of the condition. Treatment options for gallstones can vary from dietary changes and nontraditional therapies to more invasive procedures like endoscopic interventions or cholecystectomy (gallbladder removal). While the gallbladder is significant for digestion, it can be removed without major long-term effects for most individuals. Additionally, gallbladder cancer is rare but can occur, primarily affecting older adults, and may be linked to a history of gallstones. The gallbladder's historical significance in various medical traditions highlights its perceived importance in health and well-being.
Gallbladder
Anatomy or system affected: Abdomen, gastrointestinal system
Definition: A small, pear-shaped sac located under the liver that stores and concentrates bile
Structure and Functions
The gallbladder is part of the digestive system. Bile originates in the liver and then flows into the gallbladder through a system of ducts. Some bile flows directly into the small intestine, however, the gallbladder collects and concentrates much of this. The gallbladder then contracts and releases more bile into the small intestine as food is eaten. Bile helps break down the fats and neutralize the acids in the food. The organs and ducts that transport bile are collectively called the biliary system and include the gallbladder, liver, pancreas, stomach, small intestine, and the ducts connecting these organs.
Disorders and Diseases
Gallstones are a very common gallbladder problem. Two types of stones may form. Cholesterol stones are the most common type of gallstone, and they form when there is too much cholesterol in the bile. Pigment stones are less common, occurring only about 20 percent of the time; they are formed when there is too much bilirubin in the bile. Gallstones may be any size, ranging from tiny stones, like grains of sand, to the size of a golf ball. When stones are small, they may form a type of “sludge” that affects the functioning of the gallbladder. If they are large, then they may move about and cause blockage of the ducts that drain the bile from the gallbladder into the digestive system, causing pain or a “gallbladder attack.” Stones may exit the gallbladder and block other digestive system areas, causing pain, infection, or organ damage. However, it is possible to have gallstones that cause no pain or problem at all.
Some risk factors for gallstones include being female (especially females who have been pregnant or have taken hormones), being overweight, losing weight quickly (such as with “crash” dieting), or having high blood cholesterol levels. Age is a factor, with those over 60 having a greater likelihood of contracting the disease. A family history with gallstones or diabetes is another common indicator. Certain racial groupings also have a higher incidence such as Native Americans.
Common symptoms of gallstones include pain in the upper right abdomen (especially within thirty minutes after a fatty meal), nausea, vomiting, fever, indigestion, gas, constipation, diarrhea, or bloating. Stones blocking the common bile duct are likely to cause symptoms such as jaundice, dark urine, and rapid drop in blood pressure. Some relief may be found by following a low-fat diet, and some patients find relief through nontraditional methods, such as acupunctureor herbal medicine. Drug therapies are often employed and include medications such as statins and ezetimibe. More conventional treatments may involve dissolving the gallstones by various methods; however, once they begin to form, they are very likely to return, so this option may not be long-lasting. A common procedure is called an endoscopic intervention. This is typically done for minor gallbladder complications. The procedure involves the use of x-rays and an endoscope. This is a device that is essentially a flexible tube with a lighted camera that is guided down a person’s throat and into the upper part of the small intestine. The patient is administered anesthesia for the process which can be completed in several hours.
Another possibility is performing a therapeutic endoscopic retrograde cholangiopancreatography (ERCP), which allows removing stones or opening ducts. In complicated or recurring cases, the treatment for gallstones involves removing the gallbladder (cholecystectomy). All bile flows directly from the liver into the small intestine without the gallbladder. In most people, gallbladder removal has almost no side effects; in a small percentage (approximately 1 percent), bile traveling directly into the small intestine can cause diarrhea.
Untreated gallstones can become life-threatening due to infection or organ damage because of blockages, and complications including gangrene and perforation of the gallbladder can occur. People with diabetes are, for unknown reasons, more likely to have serious complications from gallstones.
Gallbladder cancer is quite rare, with new cases of less than ten thousand per year in the United States. It is seen most often in people aged seventy and older and is more common in women than in men. The cause of gallbladder cancer is unknown, but risk factors include a history of gallstones, porcelain gallbladder (a rare condition where calcium lines the walls of the gallbladder), smoking, family history of gallbladder cancer, and obesity. There are usually no symptoms of gallbladder cancer; most cancers are found incidentally during surgery to remove gallstones. Surgery to remove the gallbladder, radiation therapy, and/or chemotherapy are all possible treatments for gallbladder cancer.
Perspective and Prospects
The gallbladder has been recognized throughout history as an important organ in the digestive process. It is one of the organs in the “four humors” system of medicine, which may have originated in Mesopotamia or Egypt but reached its height in the Greek system of medicine. In that system, the gallbladder was linked to the season of summer and the element of fire, and an overabundance of bile was thought to cause one to be bad-tempered or “choleric.” In traditional Chinese medicine, the gallbladder is thought to affect the quality and length of sleep.
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