Surgeon explains gallstones and gallbladder problems скачать в хорошем качестве

Surgeon explains gallstones and gallbladder problems

Today we are talking about gallstone problems. Let’s describe some anatomy. When you swallow food it comes down your esophagus to your stomach. The stomach empties into the first part of the small intestine called the duodenum which curves around in a C shape and then runs down as the rest of the small intestine. The liver sits in the right upper abdomen. The liver makes bile which is the green liquid that helps you digest your food. The bile flows out of the liver in a tube called the bile duct which comes down behind the intestine and empties into the duodenum through a muscle called the sphincter of Oddi. The last part of the bile duct actually runs through the pancreas gland which is tucked in the loop of duodenum and lies behind the stomach. The pancreas also makes pancreas juice which helps you digest proteins in your food. The pancreatic fluid flows through another small duct tube called the pancreatic duct. The pancreatic duct drains into the same area as the bile going into the duodenum. The gallbladder is attached to the main bile drainage tube by a shorter smaller tube called the cystic duct. The gallbladder is loosely stuck under the liver. The function of the gallbladder is to store bile. When you eat, hormone stimulation causes the gallbladder to contract and squeeze extra bile into the intestine to help you digest your meal. Gallstones form in the bile as it sits in the gallbladder. This is from a combination of chemical imbalance in the bile itself and sometimes because the gallbladder is not squeezing properly. The gallstones usually start as a thick sludge then grow like pearls into more round individual stones over time. Describes gallstone and gallbladder problems. The term for gallstones in the gallbladder is cholelithiasis. Not everybody with cholelithiasis will have problems or even know they have gallstones. Symptoms occur when the stones get stuck here in the cystic duct and prevent the gallbladder from emptying properly when it squeezes. It is like a ball-valve mechanism that blocks the emptying of the gallbladder where it connects to the cystic duct. So after you eat a meal the gallbladder squeezes trying to eject the bile but it can’t because the gallstone is blocking it. This causes pain in the right upper abdomen that can radiate to the back or the right shoulder and can be associated with nausea. If this is happening and you are noticing problems related to gallstones then we call this symptomatic cholelithiasis. Once you start having symptoms, the problems tend to persist and don’t go away on their own so we usually recommend removing the gallbladder. The next level of problem, though, is when the stone is stuck in the cystic duct opening and stays there. The bile then can’t get out of the gallbladder at all and bacteria start to grow in the bile and the actual gallbladder gets infected. This is called acute cholecystitis. Acute cholecystitis has the same symptoms of right upper abdominal pain and nausea but also fevers, and elevated white blood cell count on your lab bloodwork. The other problems with gallstones are when they get out of the gallbladder and get into the bile drainage tube. If the gallstone is in the main bile drainage tube coming from the liver this is called choledocholithiasis. Choledocholithiasis can be dangerous – one reason is that it can cause infections in the bile coming from the liver. A blocked bile drainage tube with infection in the bile is called ascending cholangitis. The infection in the bile can get into the blood and cause sepsis relatively easily with cholangitis. Choledocholithiasis and cholangitis are treated by unblocking the bile duct usually by using an endoscopy scope that comes through the mouth and comes into the bile duct through the opening into the intestine. The stones in the bile duct are pulled out into the intestines and sometimes the muscle that controls the connection between the bile duct and intestine is cut to allow the stones to come out. This endoscopy is called an ERCP. The other problem with gallstones that get out of the gallbladder and into the bile duct is this can irritate the pancreas. The pancreas juice likes to drain into the same area as the bile and if the gallstones irritate the pancreas drainage this causes inflammation of the pancreas called pancreatitis. Any problems that are caused by gallstones getting out of the gallbladder and into the main bile duct are still an indication to remove the gallbladder itself since this is the source of the stones.