The gallbladder is a pear-shaped organ in the upper right quadrant of the abdomen that stores and concentrates bile, a fluid that digests fat. When the gallbladder is working normally, it releases bile into the upper small intestine in response to food intake. Sometimes bile in the gallbladder hardens into stones that can be tiny or as large as golf balls. This condition, called cholelithiasis, can cause severe pain, nausea, vomiting and yellowing of the skin and the whites of the eyes. Treatment depends on the severity of the symptoms.
Supportive Therapy
Patients who are in pain during a gallstone attack but have no complications may be given intravenous narcotics or ketorolac to make them more comfortable, according to University of Maryland Medical Center. Patients with acute cholecystitis—inflammation of the gallbladder—need intravenous antibiotics and fluids, pain medication and antibiotics to reduce inflammation before surgery can be performed.
Medications to Dissolve Gallstones
Patients who cannot tolerate surgery may be offered medication made from bile acid to dissolve the gallstones, reports MayoClinic.com. Medications administered by mouth, including ursodiol and chenodiol, are most effective in treating small stones. Therapy may take years or months to completely dissolve the stones and recurrence within five years is common. As of 2010, contact dissolution therapy, an experimental injection of a drug that can dissolve stones in one to three days, is being tested, according to the National Digestive Diseases Information Clearinghouse.
Extracorporeal Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy, a procedure that breaks up gallstones, is used only for patients who cannot withstand surgery, according to the NDDIC. ESWL works best on small, solitary stones. High energy, ultrasound shock waves are directed through the soft tissues of the body, breaking up the stones into pieces small enough to be passed out through the intestines. Oral dissolution treatment helps to break the fragments up further. Stones tend to recur, particularly in younger people, and eventually surgery may be needed.
Cholecystectomy
The gallbladder is not necessary for digestion, so surgical removal is often the treatment of choice when the patient has severe or frequent gallstone attacks, according to the NDDIC. Most gallstone operations are done through a small incision using laparoscopy---instruments guided by a tiny camera. In 5 percent of gallbladder operations, a larger incision is needed. Sometimes the surgery is done on an emergency basis, but often it is scheduled electively.
