The gallbladder is a small organ that rests under the right lobe of the liver and functions as a storage container for bile produced by the liver. Fats released from the stomach stimulate the gallbladder to contract and release bile into the intestine, aiding in the digestion of these fatty foods. Many diseases can affect the gallbladder, including cancer, infection or obstruction of the vessels that carry bile. All of these diseases require gallbladder surgery and have similar signs and symptoms.
Abdominal Pain
When gallbladder outflow becomes obstructed, it still continues to contract when stimulated by fatty foods. This produces a pain localized to the right upper side of the abdomen and the area directly below the sternum overlying the stomach. Described as a band-like tightness, the pain is constant, building in intensity after eating a fatty meal and often radiating to the right shoulder. This discomfort can also be associated with nausea and vomiting. If the gallbladder becomes infected, the pain becomes more intense in the right upper abdomen, and deep palpation in this area can produce a sharp, stabbing sensation. This is known as a Murphy's sign. In addition to removing the gallbladder, treatment includes antibiotics to prevent infection.
Jaundice
Red blood cells have a normal lifespan of 90 days. When these cells die, their byproducts are broken down in the liver and secreted in bile, giving bile its characteristic green color. If the biliary system becomes obstructed and bile is not released into the intestine, these byproducts accumulate in the skin and other organs of the body. This is called jaundice. The first manifestations of jaundice are a yellowing of the whites of the eyes and the area under the tongue. If the obstruction is not corrected, jaundice progresses to cause a distinct yellowing of the skin. Depending on the cause, the obstruction is removed using different methods, including an open-abdominal operation, laparoscopic surgery or the use of a scope inserted into the biliary tract via the mouth, stomach and upper intestine.
Charcot's Triad and Reynold's Pentad
Fever greater than 100.4 degrees F, pain in the right upper abdomen and jaundice make up a diagnostic set known as Charcot's triad. It is indicative of bile obstruction coupled with a severe infection. If the situation is not corrected and the infection worsens, the symptoms of altered mental status and low blood pressure can manifest. This is called Reynold's pentad and is a medical emergency. Treatment is the immediate decompression of the obstructed biliary system through an open-abdominal operation, leaving drains in place to allow infected bile to exit the body. After a period of decompression and antibiotics administration, the gallbladder is removed and the initial cause is corrected.
References
- "Sabiston Textbook of Surgery, 18th Edition;" C.M. Townsend, R.D. Beauchamp, B.M. Evers, K.L. Mattox; 2007
- University of Maryland Medical Center: Gallstones and Gallbladder Disease ymptoms
