CLICK HERE FOR INFO! Cartersville Surgical Associates, PC 970 Joe Frank Harris Parkway Cartersville, GA 30120 Phone: 770.386.1261 Fax: 770.386.3873 Gallbladder disease Symptomatic gallbladder disease is a very common problem, affecting 10-15% percent of the American population. Over 500,000 cholecystectomies are performed each year. Surgery may be done for biliary colic, a condition which causes intermittent pain, or for acute cholecystitis, an acute inflammatory process involving obstruction of the cystic duct. What is the gallbladder: The gallbladder is a pear shaped organ located in the right upper quadrant, attached to the liver, which functions to store bile. Bile is produced in the liver, and stored in the gallbladder. Bile ducts which begin in the liver, transport the bile to the gallbladder. The gallbladder contracts in response to stimulation by cholecystokinin, a hormone produced by the cells of the small intestine. Release of cholecystokinin is stimulated by eating, most significantly by the intake of fatty foods. The contraction of the gallbladder results in delivery of bile to the small intestine to help in solubilization and emulsification of fats. How are gallstones formed? Most gallstones found in the western population are cholesterol stones. Patients from eastern cultures are more prone to have bile pigment stones. Cholesterol stones are formed by an abnormality of cholesterol solubilization in bile. Gallstones vary in size, shape and number. The size of gallstones is important because smaller stones are more likely to pass from the gallbladder and cause complications such as pancreatitis or bile duct obstruction. Gallstones are seen in all age groups, but are more common in older patients. Other risk factors for the development of gallstones and gallbladder disease are: Family history of gallbladder disease Obesity High cholesterol levels Women on oral contraceptive pills Chronic intestinal inflammatory conditions such as Crohn's Disease And ulcerative colitis. What are the symptoms of gallbladder disease: Not all patients with gallstones will develop symptoms. For patients who are truly asymptomatic, no surgery is necessary. Symptoms include: . Intermittent right upper quadrant or epigastric abdominal pain . Nausea and vomiting . Bloating . Back pain . Shoulder pain . Fever . Chills . Jaundice . Pale colored stools (acholic stools) The symptoms of cholecystitis are frequently intermittent and may intensify over time. Attacks of pain are often exacerbated by eating, particularly fried or fatty foods. Patients with acute cholecystitis may develop fever and chills, with more severe and unrelenting pain. If a gallstone passes from the gallbladder and blocks the common bile duct, the patient may become jaundiced. Jaundice is most easily detectable by examining the sclera of the eyes or the color of the tissue under the tongue. In cases of severe jaundice, patients may have itching in the hands. How is gallbladder disease diagnosed? How is gallbladder disease treated: Symptomatic gallbladder disease is best treated operatively. Though there are medicines which can temporarily dissolve gallstones, these medicines in general work very slowly and will not prevent recurrence of symptoms. Most gallbladder surgery is done laparoscopically, with a relatively short hospital stay after surgery. In fact, some patients may be able to go home immediately after surgery, though most patients will spend one night in the hospital. How is laparoscopic cholecystectomy performed? Laparoscopic cholecystectomy is done through a series of small incisions in the abdominal wall. The largest incision is typically 1-1.5 cm in length and located at the umbilicus. The other 3 incisions are less than a centimeter in size and located in the upper abdomen. The laparoscope (camera) is introduced through the umbilical incision and used to visualize the liver and gallbladder so that the surgeon can utilize the remaining sites to introduce instruments to remove the gallbladder. Your surgeon may choose to perform a cholangiogram (an x-ray study of the bile ducts), if there is a suggestion of bile duct obstruction. Surgery typically takes 30-45 minutes, and most patients go home the day following surgery. What are the risks and complications of surgery? What can I expect after surgery? Most patients will experience some back and right shoulder pain for several hours after surgery. You will be allowed to eat following surgery, first having a clear liquid diet, and subsequently offered a regular diet if you have no nausea or pain with liquids. Though some patients may go home the same day as surgery, many patients will spend the night in the hospital. Most patients are able to resume most of their activities within 7-10 days post op. We ask that patients do no lifting greater than 30 pounds for 4 weeks post op to minimize the risk of hernia formation. Patients may shower the day following surgery. In most cases, the incisions are closed with subcuticular sutures, meaning that no sutures will have to be removed. The band aids or dressing placed in the operating room can be removed the day following surgery. The steri-strips placed on the wound can be removed 3-5 days post op. Most patients will develop some diarrhea post operatively, which generally will last for several weeks. Minimizing your fat intake may improve this diarrhea. Paitents should be able to drive 3-5 days post op, depending upon their general medical condition and their level of discomfort. We discourage driving when patients are requiring narcotic pain medicine for pain control. Your physician will see you approximately one week after surgery to assess your wounds and your general condition. Your follow up appointment should be made at the time of discharge. If no followup appointment is made at the time of discharge from the hospital, please call our office at 770.386.1261 to schedule your follow up visit.