The gallbladder is a small sac which sits under the liver and stores bile after it is produced by the liver. After a meal the gallbladder contracts and empties bile through the cystic duct (tube) and bile ducts into the small intestine to help digest fats. Gallstones are formed in the gallbladder from cholesterol and other material found in bile when not digested properly. Gallstones may be tiny or as large as a golf ball, are quite common, and most people will have no symptoms. When gallstones obstruct the flow of bile from the gallbladder pain will occur. The pain can be quite severe and is typically located in the right upper abdomen. These attacks are often associated with nausea and vomiting, and typically occur after eating; particularly fatty meals. Most attacks will resolve within hours. Gallstones do not cause symptoms and require no treatment, but if symptoms are continue to happen, the gallbladder should be removed surgically.
Cholecystitis occurs when a gallbladder stone (explained above) travels out of the gallbladder and becomes trapped in the cystic duct (the tube which drains the gallbladder). This causes the gallbladder to swell and become infected by bacteria. Symptoms include pain in the right upper abdomen, fever, nausea, and vomiting. The diagnosis is made by a history of typical symptoms, physical examination, blood tests, and an imaging study of the abdomen such as an ultrasound. The obstruction of the cystic duct can be confirmed by a nuclear medicine test known as a HIDA scan which evaluates gallbladder function. Treatment for cholecysitis usually consists of antibiotics and surgical removal of the diseased gallbladder.
(Choledocholithiasis) is the presence of a gallstone in the common bile duct, the tube which drains the liver and gallbladder into the small intestine. Occasionally a gallstone will travel out of the gallbladder and become lodged in the common bile duct. It will not pass spontaneously into the small intestine because of the sphincter muscle at the end of the common bile duct. The obstructing stone will cause pain in the upper abdomen. If infection ensues, (cholangitis) the patient will also complain of fever and severe chills. A stone trapped in the bile duct is suspected when an ultrasound reveals gallbladder stones and blood tests show abnormally elevated liver enzymes. During the ultrasound the bile duct may also be enlarged or swollen due to the obstruction. If enlarged, the bile duct should be removed surgically.
(Cholangiocarcinoma) is a malignancy arising from the cells that line the bile ducts. This results in narrowing and obstruction of the liver's drainage system. The cancer can occur in the ducts within the liver (intrahepatic ducts) or in the ducts that connects the liver to the small intestine (common hepatic duct and common bile duct). The obstruction rarely causes pain but frequently causes yellowness of the eyes and skin (jaundice), itching, and weight loss. The diagnosis is suspected when blood tests reveal abnormally elevated liver enzymes and an imaging study such as ultrasound, CT scan, or MRI scan, demonstrates swelling or dilatation of the bile ducts above the obstructing cancer. Definitive treatment options include surgery to remove and possibly cure the cancerous growth or chemotherapy/radiation therapy to shrink it.
A stricture (a narrowing of the bile duct) can occur in the ducts within the liver (intrahepatic ducts) or in the ducts that connects the liver to the small intestine (common hepatic duct and common bile duct). The obstruction rarely causes pain but frequently causes yellowness of the eyes and skin (jaundice) and itching. A stricture may be benign and related to scarring from previous surgery or other uncommon bile duct conditions. It may also be malignant due to a cancerous growth arising from the cells that line the bile duct (cholongiocarcinoma) or from a cancerous growth in an adjacent organ compressing the duct, most commonly pancreatic cancer. Cancerous growths within the liver or the lymph nodes beneath the liver can also cause obstruction and strictures of the bile ducts.
This term refers to abnormal function of the sphincter muscle at the end of the bile and pancreatic ducts; the tubes that drain the liver and pancreas into the small intestine through a small nipple-like opening called the papilla. The sphincter is a circular band of muscle tissue which controls the release of bile and pancreatic juices though an opening in the papilla into the intestine. Abnormal relaxation of the sphincter prevents normal flow of bile or pancreatic juices into the intestine. This may cause episodic upper abdominal pain and even pancreatitis (see separate discussion under pancreatic disorders). The diagnosis is considered in patients with typical pain and abnormally elevated liver enzymes in the absence of gallstones or other causes of bile duct obstruction. The diagnosis should also be considered in patients with repeated and unexplained episodes of pancreatitis.