GallBladder

What is Gallbladder & Its Function

It is a pear type structure located on the undersurface of right lobe liver inferiorly, that’s why pain of gallbladder disease is located on right upper abdomen; Liver produces bile and part of it get stored in the Gallbladder; function of bile is fat digestion; in the absence of gallbladder, bile produced by the liver trickle in continuous fashion and help in fat digestion that’s why post-operatively after removal of it our body gets adapted and after 4-6 months there is no much difference in fat digestion process.

Gallstones

Gallstones formation is common. What causes gallstones, is difficult to define. There are various theories about Gallbladder stone reason or there formation but there is no preventive method. There is no special diet for gallstones prevention

Most common gallstones symptom include right upper abdomen pain. Pain is mild to moderate in intensity and associated with vomitting. Stone impacted at neck can cause distended gallbladder or mucocele. Infection in mucocele cause pyocele or pus formation . These patients are usually diabetic and sick and require urgent medical treatment. 20-30% can have dyspeptic symptoms

Ultrasound abdomen is the most common investigation done for any abdomen complaints. It is the most sensitive test for gallstone detection, even better than CT Scan. Associated complications with gallstone which should be looked for in USG include CBD stones, dilatation of CBD, any associated features of acute pancreatitis. MRI/MRCP should be done in suspected cases of CBD stones

There is no role of medicine or Ayurveda in treatment of gallstones.The stone specialist or best doctor are the laparoscopic surgeon as the recommended gallbladder stones treatment is gallbladder removal. The operation or surgery for gallbladder stone removal is called as Laparoscopic Cholecystectomy, in which whole of the gallbladder is removed Laparoscopy or by minimally invasive approach; It is a day care surgery in which patient is operated in the morning and can be discharged in the evening and from next day onward patient can do normal day to day activities

Because of complications of Gallstones such as Jaundice/ Cholangitis/Pancreatitis/Cancer even in asymptomatic patients, Surgery is preferred

The gallbladder removal side effects are minimal. Initially for a period of 2-3 months patient is advised to avoid excess fat in the diet

There are many factors which decide the cost of surgery. Other than hospital it also depends on patient general condition and room category. In metro cities like Delhi, Noida & Ghaziabad cost is more compared to other two tier cities. The gallbladder removal surgery or stone operation cost varies from INR 40,000 t0 90,000

Gallstones

Gallbladder

Cancer Gallbladder

Gallbladder Cancer is common in North India and patient most commonly present with right upper abdomen pain, other symptoms can be loss of appetite/weight loss/jaundice/vomiting; Vomiting and Jaundice occur when the tumor spread locally and involve duodenum or pylorus and biliary system respectively

USG abdomen is the first modality of investigation whenever patient present with pain abdomen; USG in these patients show irregular GB wall thickening/GB mass; CECT abdomen is done in suspected Gallbladder Cancer on USG, as CT gives more idea about the mass/thickening, local and distant spread; FNAC is not done as it may cause seedling of tumor cells along the needle tract, MRCP is done when patient present with jaundice; Upper GI Endoscopy is done in suspected duodenal/pylorus involvement

Surgery is the treatment of choice if tumor is resectable and patient is fit for surgery, role of chemo or radiotherapy is less; First Staging Laparoscopy is done and if no distant metastases is detected in staging laparoscopy then right subcostal incision is given, first inter aorto-caval lymph node sampling is done and if negative for malignancy then radical cholecystectomy with lymphadenectomy is performed in which segment IV B and V of liver is resected; Intra-op cystic duct margin is sent for frozen section if it is positive then CBD exicision with Roux-en-Y Hepatico-jejunostomy is done

Locally advanced tumors can involve duodenum/pylorus/hepatic flexure/Biliary system; In these cases tumor is removed en-bloc with involved organs; when the tumor involve biliary system and patient has jaundice and a major liver resection is planned pre-operative biliary drainage is done to lower down the bilirubin level before surgery