rate of red blood cell turnover. Bilirubin is the main
component of pigment gallstones, and these diseases
increase amounts of bilirubin formed in the liver.
Many people with gallstones and never have any
symptoms. Symptoms tend to occur when a gallstone
moves out of the gallbladder and irritates or blocks the
common bile duct or the entrance to the pancreatic
duct. Sometimes symptoms come and go, as when
stones irritating bile duct move into the much larger
small intestine.
Symptoms can include the following:sudden pain in the upper right part of the abdomen
that lasts anywhere from 15 minutes to several hours
and does not go away with changes in position.
pain radiating up into the back or right shoulder
blade
nausea and vomiting
fever
jaundice, a yellowing of the skin and whites of the
eyes
Pain can occur frequently or at long intervals.
Jaundice and fever are signs of advanced gallstone dis-
ease and infection. Sudden intense pain, especially if
accompanied by high fever, nausea, vomiting, jaundice,
and dark urine are signs of a medical emergency. Med-
ical care should be sought immediately. Untreated bile
duct blockages can lead to perforation of the bile duct,
infection, and death.
Diagnosis
Diagnosis is made on the basis of a physical exami-
nation and imaging studies. Ultrasound is the least
invasive and often the most effective way to locate
gallstones. Other imaging studies, such as plain x rays
and computed tomography (CT) scans, may also be
used. These diagnostic tools may fail to located gall-
stones in the bile duct.
Other diagnostic tests can be used to better locate
gallstones in the bile duct. A radionuclide scan, also
called cholescintigraphy or HIDA scan, uses a small
amount of radioactive tracer material that is injected
into a vein. A machine locates the radioactive tracer as
it moves through the body and in this way can tell if a
stone is blocking the entrance or exit to the gallbladder
or the common bile duct. Endoscopic retrograde chol-
angiopancreatography (ERCP) is an endoscopic proce-
dure use to locate, and sometimes remove, gallstones
from the bile and pancreatic ducts. In this procedure, a
thin tube called an endoscope is passed down the
throat, through the stomach, and into the first part of
the small intestine. Air and dye are then injected that
allows the physician to see the place where the bile duct
empties into the small intestine. If stones are present, a
special tool may be inserted through the endoscope to
remove them.Treatment
By far, the most common and most successful
treatment for gallstone disease is surgical removal of
the gallbladder, an operation called a cholecystectomy.
Removing the gallbladder has little effect on digestion.
Bile simply goes directly from the liver to the small
intestine instead of being stored. The difference is that
the intestine receives a continuous flow of bile rather
than receiving it only when it is needed. In about 1% of
people, this continuous flow of bile causes mild
diarrhea.
Most gallbladder surgery can be done laparos-
copically. This means that surgery is done through a
small cut in the abdomen instead of opening the entire
abdominal cavity. A thin instrument called a laparo-
scope that contains a miniature video camera and a
light is inserted through the cut. The surgeon uses the
image from the video camera to insert small instru-
ments through the incision and remove the gallblad-
der. Recovery from laparoscopic gallbladder surgery
often takes only a few days.
If the gallbladder or pancreas is infected, a serious
complication, or if there is scarring from previous
surgeries, open gallbladder surgery is necessary. This
involves making a large incision in the abdomen.KEY TERMS
Bile—a greenish-yellow digestive fluid produced
by the liver and stored in the gallbladder. It is
released into the small intestine where it helps
digest fat, and then is removed from the body in
feces.
Bilirubin—a yellowish pigment found in bile that is
produced through the normal breakdown of red
blood cells
Cholesterol—a waxy substance made by the liver
and also acquired through diet. High levels in the
blood may increase the risk of cardiovascular
disease.
Pancreas—a gland near the liver and stomach that
secretes digestive fluid into the intestine and the
hormone insulin into the bloodstream.
Perforation—a whole in the wall of an organ in the
bodyGallstones