Susan Blatt, MD

The gall bladder is located in the right upper abdomen, under the liver.  Bile, which is produced in the liver, is stored in the gall bladder.  Interestingly, if the gall bladder is removed, most people do not have any ill effects.  When stones form in the gall bladder, inflammation and pain may develop. Gall bladder disease is associated with being overweight and is more common in women than men.

Bile is a liquid that contains waste products from the breakdown of hemoglobin and also enzymes used in the digestion of fatty foods.  Bile leaves the liver and travels through ducts into the gall bladder. When enzymes are needed, bile then travels through another duct to the small intestine

Sometimes crystals or stones form in the gall bladder.  Most often gallstones are made up of crystals of bile, but cholesterol also may form stones.  Most gallstones cannot be seen with a normal x-ray.  In the past, a dye was used to outline stones in the gallbladder, so that they would show on x-ray.  Now ultrasound is used and stones can be seen without the need for x-ray or dye.

If gallstones do not cause any symptoms, the gall bladder can stay in place.  It is estimated that 20% of adults may have “silent” gallstones.  If symptoms do occur, they are caused by inflammation of the wall of the gall bladder.  Symptoms of gall bladder inflammation (called cholecystitis) include right upper abdominal pain, nausea, and fever.

Patients who have inflammation of the gall bladder have attacks occurring from time to time, lasting several hours. After a heavy meal, high in fat, the gall bladder contracts to provide digestive enzymes in the small intestine. If there are stones, the stones may obstruct the opening of the gall bladder and inflammation results, which causes pain. The liver and pancreas are related organs and may be damaged if there is obstruction and inflammation in the gall bladder. There are blood tests to evaluate the status of the pancreas and liver.  Pain medication is used, during gall bladder attacks, to relieve the discomfort.

If a person has persistent attacks of pain from gallstones, surgical treatment is usually recommended.  Surgery may be done immediately or postponed for a few weeks to let the inflammation resolve.  The gall bladder is usually removed through a small incision using a laparoscope.  Some people need to have traditional surgery, for instance if they have scar tissue inside the abdomen from previous abdominal surgery. There has not been an effective, safe medication developed to dissolve gallstones.

Sometimes stones pass from the gall bladder into the ducts and then cause obstruction in a duct.  Special tests are used to identify these stones.

It appears that persons who eat low fat meals and who stay thin seldom have problems with gallstones. For persons with silent gallstones, improving the diet may postpone the need for surgery.  Surgical treatment is usually simple, and recovery occurs in a few days.