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Gallbladder Disease

17:15 EST 22nd November 2017 | BioPortfolio

Gallstones are small, hard deposits that form in the gallbladder, a sac-like organ that lies under the liver in the upper right side of the abdomen. They are common in the wealthy countries, affecting 10-15% of adults. Most people with gallstones don't even know they have them. But in some cases a stone may cause the gallbladder to become inflamed, resulting in pain, infection, or other serious complications.

The formation of gallstones is a complex process that starts with bile, a fluid composed mostly of water, bile salts, lecithin (a fat known as a phospholipid), and cholesterol. Most gallstones are formed from cholesterol.

Bile is important for the digestion of fat. It is first produced by the liver and then secreted through tiny channels that eventually lead into a larger tube called the common bile duct, which leads to the small intestine.

Only a small amount of bile drains directly into the small intestine, most flows into the gallbladder through the cystic duct, which is a side branch off the common bile duct. This system of ducts through which bile flows is called the biliary tree.

The gallbladder is a 4-inch sac with a muscular wall that is located under the liver and serves as a reservoir until bile is needed in the small intestine to digest fats. This need is signaled by a hormone called cholecystokinin, which is released when food enters the small intestine.

Cholecystokinin causes the gallbladder to contract and deliver bile into the intestine. The force of the contraction propels the bile down the common bile duct and into the small intestine, where it emulsifies (breaks down) fatty molecules.

This part of the digestive process enables the emulsified fat, along with important fat-absorbable nutrients (such as vitamins A, D, E, and K), to pass through the intestinal lining and enter the bloodstream.

Diagnosis

The accuracy of diagnostic results has improved significantly with advances in ultrasonography, CT, MRI, and scintigraphy. 

Treatment

  • Single-incision laparoscopic cholecystectomy (SILC) requires more operating time, cosmetic satisfaction was higher among patients who had SILC compared to those who underwent traditional (4-port) laparoscopic surgery.
  • Endoscopic Retrograde Choliangiopancreatography (ECRP) with endoscopic sphincterotomy is the most common procedure for detecting and managing bile duct stones.
  • Intraoperative endoscopic sphincterotomy (IOES) is just as effective and safe as preoperaative ES (POES) in patients with gallbladder and bile duct stones.
  • Natural Orifice Translumenal Endoscopic Surgery (NOTES) is enabling surgeons to remove the gallbladder through the mouth, stomach, rectum or vagina. The first two transoral and transvaginal cholecystectomies in the NOTES clinical trials were recently performed in the U.S.

Adapted from: Gallstones and gallbladder disease | University of Maryland Medical Center http://umm.edu/health/medical/reports/articles/gallstones-and-gallbladder-disease

 

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