Gallbladder

The gallbladder is a bag-shaped organ in the lower part of the liver, where bile secreted from the liver is accumulated. Approximately 500-1500 ml of bile is secreted from the liver per day and performs a variety of functions including the absorption of fats and some vitamins from the intestines, in particular. The gallbladder stores some of this bile and contracts, contracts and pushes its contents into the duodenum to help digestion, especially after the consumption of fatty foods, chocolate, eggs.

How Do Gallstones Develop?

The normal fluidity of the gallbladder is not a problem, but in cases of prolonged starvation, the fluidity of bile decreases and starts forming sediments. These formed sediments pave the way for gallstone development. Gallstones are soft, easily crushable stones gray-brown in color, which are mostly composed of cholesterol crystals. They are black, hard pigment stones, very few of which consist of calcium and bilirubin.

What is Cholecystitis (Inflammation of the Gallbladder)?

Gallstones mostly exist passively in the gallbladder, without causing any complaints, and they are detected incidentally during checkups or examinations intended for the diagnosis of other diseases. If these stones block the gallbladder duct, the flow of bile is disrupted and edema develops on the wall of the bladder, causing the impairment of its vascularity. An excess of the number of stones, the presence of millimetric ‘small stones’ and stones with a diameter greater than 2-3 cm cause increased risk of gallbladder inflammation. As the blockage lasts longer, rotting and perforation may occur on the gallbladder wall. This condition often causes symptoms such as ABDOMINAL PAIN. The pain is felt in the upper right side of the abdomen, and in the back, under the right scapula. In addition to pain, complaints such as indigestion and bloating may occur. If the gallbladder is punctured, abdominal disease (acute abdominal syndrome) develops, which occurs with a very severe abdominal disease that makes it hard to breathe and requires urgent surgical intervention. Time is important in such a case. It is necessary to see a general surgery specialist as soon as possible.

Other Diseases Associated with Gallstones

Especially when small millimetric stones fall from the liver into the main bile duct connected to the duodenum, and block the main bile duct, they may cause the disease that can cause significant damage to the liver, which darkens the color of urine, causes obstructive jaundice, which is also known as germ-free jaundice, aggravates and improves from time to time, and causes colic pain. If the symptoms also include infection and fever,, inflammation of the biliary tract called CHOLANGITIS may develop.

If stone(s) block the entrance of the duct that opens into the duodenum of the bile duct, it may cause a very serious disease called PANCREATITIS. Pancreatitis can be overcome very easily but can also be experienced so severely that it may require intensive care and even result in a fatal process.

Predisposition Groups

It is more common among people over 40 years of age, women, overweight people, and white-skinned people.

Diagnosis

  • Anamnesis and physical examination
  • Complete blood count, biochemical tests intended to determine the condition of the liver and biliary tract
  • Ultrasonography(USG), which is the easiest and fastest technique for diagnosis
  • In some cases where necessary, abdominal tomography and magnetic resonance cholangiography (MRCP) are performed in order to reveal problems, especially with the biliary tract
  • The endoscopic procedure called ERCP, which can reveal problems with the biliary tract and ensure the removal of the stones from the region.

Treatment

We usually recommend non-operational follow-up of gallstones, which are often diagnosed incidentally because they do not cause discomfort, and of patients aged 70 to 75 years and older, who do not have an inflammatory gallbladder condition called acute cholecystitis.

We recommend SURGERY in cases of;

  • Gallstones with a millimettic-diameter, which have the risk of clogging the gallbladder duct and spilling into the main bile duct, causing obstruction there
  • Gallstones with a diameter larger than 2 cm, which cause chronic gallbladder inflammation and the possibility of gallbladder cancer, albeit with a significantly low risk
  • Stones that cause complaints of pain, indigestion, bloating, and other similar complaints, regardless of their diameter
  • Gallstones in the presence of diabetes, which can lead to a risk of rapid infection, puncture, and decreased sensation of pain.
  • Gallbladder polyps (fleshy protrusions) larger than 5 mm in diameter(over 10 mm in particular) and polyps growing rapidly
  • Patients with inflammatory gallbladder disease (ACALCULOUS CHOLECYSTITIS) that does not contain stones
  • Inflammatory gallbladder disease (CHOLECYSTITIS) and perforation of the gallbladder.

The LAPAROSCOPIC(CLOSED)  technique is considered to be the gold standard in surgery because it does not involve cutting the abdominal muscles, allows for higher possibility of returning to home and work earlier, cause lower probability of infection and herniation of the wound, and provides better cosmetic appearance It is a surgical procedure intended o remove GALLSTONES TOGETHER WITH THE GALLBLADDER by accessing them through 3 or 4 skin incisions with a diameter of 1 cm. The procedure takes 20 minutes on average. There is a 1-2% possibility of switching from laparoscopic to open surgery.
An open surgical gallbladder operation may be preferred in the last months of pregnancy, in case of chronic obstructive respiratory diseases (COPD) that are advanced enough to disrupt respiratory function, and for patients who have a history of surgical interventions for upper digestive tract diseases and liver disease.

After a laparoscopic surgery, patients are discharged after 1 night hospital stay, and after an open surgery, patients are discharged after1-2 night hospital stay. Surgical removal of the gallbladder does not cause a significant health problem in the patient.



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