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- All About The Gallbladder |
GALLBLADER
BASICS
What's a gallbladder anyways?
The Gallbladder is basically a very handy sack
that the body uses to store [extra] bile.*
*So what the heck is bile?
Bile is that yellowish-greenish stuff we frequently see
coming out of the NGT. However, it
is not produced by the NGT, it is produced by the Liver. It travels through little tubes (canals) and into the
"common bile duct," where it then either goes into the small
intestine, or into the gallbladder to be saved for later.
Bile is essentially a yucky juice that helps us digest fat. It is primarily made up of cholesterol, [bile] acids (AKA bile salts), and bilirubin (which is produced during the breakdown of RBCs).
What make's a good gallbladder go bad?
There are primarily two problems people have with their
gallbladder:
1). Gallstones
(cholelithiasis). This you might
expected with all those salts and acids...
2). Inflamation
(cholecystitis). Usually caused by
the stones, which are, like duh, irritating.
But, having too much fun
(ETOH) and systemic illness can also cause the gallbladder to become
irritated. Tumors are rare...
What's wrong with a little inflamation?
When the in/out door of the gallbladder becomes too
inflamed, bile gets trapped. The
pissed off gallbladder is then more susceptible to inflamation, infection, and
rupture (a bad thing). The most
common symptom is abdominal pain in the RUQ right after a fatty meal, and an
elevated temp if there is an infection. Nausea
and vomiting is not very common with gallbladder disease, but if you're floating
to another unit, it might be severe...
Diagnostic tests include:
- Abdominal ultrasound, CT scan, and AbdXR.
- Oral cholecystogram: A fancier AbdXR taken in a series
with dye. The pt. may also get to
have a high-fat drink in the middle of this series to stimulate the gallbladder
into producing bile for the camera.
- Gallbladder radionuclide scan.
During this test the pt. gets a radioactive IV bolus of chemicals, and
then a special camera takes groovy glow in the dark pictures.
Sounds fun, huh?
- ERCP. Endoscopic
Retrograde CholangioPancreatography. Its
a special endoscope with a little XR camera at the end of it. With direct visualization the docs can inject dye right into
the bile ducts for superior visualization (Ohm...).
- CBC to check for elevated WBCs...
Treatment:
Occassionally, patients will get lucky and can be
treated with just ABOs, analgesics, and boring, low-fat food. Removal of the gallstones can buy some time, but only if the
patient doesn't fall off the veggie wagon...
Time for surgery!
Most gallbladder problems are resolved without mercy...
The gallbladder is simply sucked out of the patient's body through an
oversized straw! This is called a
laporoscopic cholecystectomy... Its
a great source of income for hospitals all around the country..
An emergent "open chole" may be necessary if
perforation, pancreatitis, necrosis, or inflammation of the common bile duct
occurs. BUT, if the patient is too
sick to have surgery right away, a cholystostomy tube (a.k.a. T-Tube) may be
placed to relieve the gallbladder
of bile temporarily. This
may also be neccessary if the patient waits until Friday to enter the hospital
system (as surgeons often have other priorities during the weekend).
Nonsurgical treatment includes pain medicines,
antibiotics to fight infection, and of course, the boring low-fat diet.
After surgery, most people forget they ever had a
gallbladder...
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