It’s a pear or globular thin walled hollow organ attached to liver bed and connected to the common bile duct. It acts as a reservoir of bile. Bile is concentrated in the gall bladder and prepared for digestion of fatty food.
It is a golden yellow fluid secreted from liver and carried by bile duct to gallbladder. Bile in the gallbladder is concentrated and prepared for digestion of fatty food in the intestine.
It’s a tube like structure connecting liver with the intestine. Bile is carried from gallbladder and liver to the intestine when fatty food reaches intestine.
Inner wall of the gallbladder absorbs water from bile and pour a semisolid fluid and prepare for digestion of fatty food. Gallbladder pumps the bile to the intestine via common bile duct when the fatty food reaches intestine. The process of pumping the bile is controlled by hormone.
Usually the ingredients of bile maintain a balance. Salts and pigments precipitate when this balance is disturbed resulting in stone formation.
Upper abdominal colicky pain radiating to back ( not in all patients), vomiting, flatulence after spicy food, intolerance to fatty food, indigestions following spicy food. Fatty, fertile female of forty are the candidates for gall stone disease.
Acute colicky pain upper abdomen radiating to back with/ without jaundice and with/ without fever with chill. Sometimes may be associated with Pancreatitis
Acute colicky pain upper abdomen with/ without fever followed by jaundice
Acute pancreatitis (swelling of pancreas with accumulation of fluid around the pancreas) caused due to spasm in the lower opening ( ampulla) of the bile duct probably due to plugging by bile/ stone.
Commonest and effective investigation is Ultrasound Examination
It is diagnosed by routine blood examinations and liver function tests along with Ultrasound examination. Contrast CT scan is required in specific situations.
Common bile duct stone or disease is effectively diagnosed by MRCP (Magnetic resonance cholangio-pancreatography). Endoscopic Sonography is also an effective investigation but not commonly available.
Contrast CT is done in some situations
Thorough examination and investigation to exclude other problems like diseases of lung, heart, kidney, liver, blood etc and to inform the attendants and treat them prior to surgery.
Avoid fatty ( Egg yolk, Oily fish, meat, Fried food, oily food, milk and its products) and spicy food when gall stone disease is detected. Advised to take boiled vegetables, fresh fruits, vegetable salads etc. Egg white is allowed.
Smoking, alcohol must be stopped before surgery. Medications are taken as advised by doctor. Patient is given light food on previous night and advised laxatives. Advised good bath with naval cleaning before surgery. Pre operative medications are taken on the day of surgery. Patient is not allowed anything by mouth six hours before surgery
Pre 1987 era, Gall stone diseases were treated with open surgery by making large incision. Hospital stay and recovery was prolonged.
1.Laparoscopic Cholecystectomy (Removal of Gall bladder by using laparoscope through small holes) is the method of choice for gall bladder removal due to minimal post operative pain, speedy recovery and negligible post operative scar. Hence cosmetically much superior than open surgery. Patients are discharged within 24 hrs if there are no associated diseases. With experience of more than 20000 gall bladder surgeries, laparoscopy has been safely carried out even in the badly infected gall bladder with excellent recovery.
bile duct stone can be treated by
1) Open surgery – it was the procedure in earlier days to extract stone of bile duct as there were no alternatives.
2) Laparoscopic Bile duct Surgery – I have been doing this procedure since 1998 and have pioneered the procedure in North East India. Stones more than 10-15 mm and larger stones with failed ERCP extraction are the ideal situations for this procedure.
3) ERCP (Endoscopic Extraction)– Endoscope is pushed through mouth and stomach to remove the stone from the lower end of the bile duct under radiological vision. Stones around 10 mm size or less are ideal for this procedure. But even up to 15 mm stone can be removed by experienced endoscopist. Attendants should be explained about possible complications of ERCP and Laparoscopic bile duct exploration.
Patient is put on oxygen support till fully oriented and may be kept in the recovery ward if necessary. During this period patient is not allowed mouth feeding. Light liquid is started four hours after surgery when the patient is well oriented. Semisolid after 12hours, non spicy solids after 24hours if patient recovers well. Then gradually start normal diet. Patient is advised normal movements like going to toilet. Symptomatic medications are prescribed for post operative period. Prophylactic antibiotics three doses are injected. Antibiotic is continued for minimum period of 5 days when there is infection. Wound dressing is removed after 7 days and allowed to take bath. Patient is advised to resume non strenuous work after seven to ten days.