1.Where does the gallbladder grow in the body?
The gallbladder is pear-shaped and located in the gallbladder fossa below the right lobe of the liver, attached to the liver by connective tissue, called the gallbladder bed. It sometimes contains small blood vessels and small bile ducts that connect the gallbladder to the liver. The gallbladder is divided into three parts: the base, the body, and the neck. The bottom part has a thin wall and is prone to perforation. Adjacent to the gallbladder: Upper: liver. Lower: duodenum, transverse colon (in case of cholecystitis, adhesions may occur to form fistula); left: pylorus of stomach; right: colon.
2.What is the role of the gallbladder?
The gallbladder is a blind pouch, it is slender and curved, and the cystic duct is connected with the bile duct. When the gallbladder is fasting, it receives bile secreted by liver cells for concentration, and when people eat, the concentrated bile enters the intestine to help digestion and absorption of food. When the gallbladder is removed, the function of the gallbladder can be compensated by the bile duct, which basically has no effect on the nutrient absorption of human body.
3.How is bile secreted and involved in digestion?
Bile is produced by the liver. The liver produces bile continuously, and the daily production is about 1000-2000ml, which varies with people’s activities, the quality and quantity of diet, and the amount of water drunk, and the liver produces much more bile than usual during meals. Bile has two major roles: first, as a digestive fluid, it mixes with food in the small intestine to help digest and absorb the fat in food; second, it excretes certain metabolites from the liver. Under normal circumstances, the content of various components in bile remains relatively stable. When there are large changes in various components in bile, it will cause biliary tract diseases, such as the formation of gallbladder stones or bile duct stones.
4.What diseases can be produced by gallbladder?
Cholecystitis and cholelithiasis are common diseases in abdominal surgery. It ranks third after acute appendicitis and intestinal obstruction among acute abdominal diseases. There are also benign diseases such as gallbladder polyps and adenomyosis of the gallbladder. Gallbladder cancer is a malignant disease arising from the gallbladder. It is worth mentioning that chronic diseases of the gallbladder such as chronic cholecystitis and gallbladder polyps have a much higher chance of turning into gallbladder cancer than normal people.
5.I often have poor appetite and pain and discomfort in my upper abdomen after eating, is this cholecystitis?
”Asymptomatic” gallbladder stones (quiet stones): the so-called asymptomatic means no biliary colic, almost asymptomatic, or even undetected for life. Sometimes there is only slight epigastric distention, vague pain, discomfort, belching, etc., and the symptoms are more obvious after eating greasy food, so it is easy to be treated as “hepatitis” or “gastritis”. On examination, light pressure pain in the right upper abdomen can be palpated when the gallbladder is fluid.
Biliary colic: severe colic in the right upper abdomen, radiating to the shoulder and back, accompanied by nausea and vomiting. It is caused by stone imbedding, sometimes the symptoms disappear due to position change and release of imbedding; otherwise, fever, peritonitis, shock and other symptoms may occur secondary to infection, septicemia, jaundice and perforation. Biliary colic mostly attacks after a full meal or eating greasy, and a few patients have attacks at night.
6.How can cholecystitis cause pain in my lower back?
The symptoms of cholecystitis complicated by gallstones are generally manifested as epigastric pain, mostly in the right upper abdomen, which starts as continuous pain and gradually increases to unbearable, often involving the right shoulder and back, with the patient restless, bending and rolling, sweating, often accompanied by nausea and vomiting.
7.Why do stones grow in the gallbladder?
(1) Long-term high-fat diet. High-fat diet, especially foods containing high cholesterol, such as animal brain, liver, kidney and egg yolk, can lead to an increase in cholesterol in blood and bile, which is very easy to produce gallstones. In addition, long-term high-fat diet makes people obese, coupled with poor exercise, resulting in decreased muscle tone of the gallbladder, delayed emptying of the gallbladder, bile accumulation, the formation of stones.
(2) Love sweets or excessive intake of food with high sugar content. Refined rice and flour will accelerate the accumulation of cholesterol, causing an imbalance in the ratio between cholesterol, bile acids and lecithin in the bile. Excess sugar will be converted into fat, making people fat and increasing the risk of stone formation.
(3) Long-term alcohol consumption. Long-term alcohol consumption can lead to liver fibrosis, cirrhosis, fatty liver and other pathologies, making bile evacuation blocked stasis, which is also one of the causes of gallstone disease.
(4) Irrational eating habits. Long-term skipping breakfast is prone to gallstone disease. Because of the lack of breakfast, fasting for a long time, bile secretion is reduced, easy to deposit in the gallbladder, over time, it can form gallbladder stones. (5) Drink too little water. Drinking less water will lead to blood viscosity, thick bile, and over time, gallstones will be generated. (6) Genetic factors. Due to genetic reasons, the cholesterol content in bile is too high, which can easily form cholesterol crystals and then develop into stones. Most often seen in a family with multiple members suffering from gallstones.
8. Who is prone to get gallbladder stones?
Although gallstone disease is common, not everyone suffers from gallstones. So, who is prone to gallstone disease?
Through clinical observations, experimental studies and epidemiological surveys, scientists have identified many “risk factors” for gallstone disease. People who have these “risk factors” are prone to gallstones. The “risk factors” for cholesterol stones include
(1) Older age Very few adolescents develop gallstones. The incidence of gallstones increases with age, so middle-aged and older people are more likely to develop gallstones than young people, and the older they are, the more people will develop gallstones.
(2) Women
Compared to men, women are more likely to develop cholesterol stones, and female patients are generally more than two times more likely than male patients. Women with multiple pregnancies are more likely to suffer from gallstones, and women who take oral contraceptives for a long time or are treated with estrogenic drugs after menopause are also more likely to suffer from gallstones.
(3) Obesity Obese people are prone to gallstone disease. Obese people have long-term excessive nutrition, bile contains a higher amount of cholesterol, which can lead to the formation of cholesterol stones.
(4) Diet Eating more often and food containing high amounts of animal fat, cholesterol and sugar can easily produce cholesterol stones. The Western-style diet is a major factor in the formation of cholesterol stones.
(5) Certain diseases
Patients suffering from restrictive ileitis are prone to cholesterol stones because the diseased ileum cannot fully absorb bile acids from the intestine, resulting in excessive loss of bile acids. By the same token, patients who have undergone ileal resection are also prone to cholesterol stones.
Anyone with the above “risk factors” should be constantly alert to the occurrence of gallstone disease, such as an obese woman of middle age or older, who often feels full and stuffy in the upper abdomen after meals, or even distended and painful, should promptly go to the hospital for examination to determine whether there are gallstones. Usually avoid eating too much and excessive obesity, to prevent gallstones also have a certain role.
9.Why is the gallbladder easily inflamed?
(1) The gallbladder is an enlarged part of the end of the gallbladder duct, which can hold 30-60ml of bile. The bile enters the gallbladder or is discharged from the gallbladder through the gallbladder duct, which is about 3-4cm long and 2-3mm in diameter. After embedding, the bile in the gallbladder can not be discharged, so that the excess bile accumulates in the gallbladder, stagnates for a long time and is too concentrated, which directly stimulates the gallbladder mucosa and causes inflammation.
(2) The blood vessel that supplies nutrition to the gallbladder is the terminal artery. When the outlet of the gallbladder is blocked, the mucous membrane of the gallbladder continues to secrete mucus, causing the pressure in the gallbladder to increase continuously so that the gallbladder swells and accumulates water, and the blood vessels in the wall of the gallbladder are thus pressurized and become ischemic and necrotic. When the gallbladder is ischemic, the resistance of the gallbladder decreases, and bacteria can easily grow and multiply, taking advantage of the opportunity to move around and develop cholecystitis.
(3) Because the gallbladder has the function of storing and concentrating bile, the contact time between the gallbladder and bile is longer than other bile ducts, and the concentration of bile in contact is also high, when there are bacteria in the bile duct at this time, infection will occur and the chances of forming cholecystitis will certainly increase.
10.What is gallbladder polyp?
Gallbladder polyp-like lesion is a general term for all non-stone lesions in which the wall of gallbladder grows into the lumen in the shape of polyps. In China, with the widespread use of ultrasound technology, the detection rate of gallbladder polyp-like lesions is getting higher and higher, and their clinical and pathological characteristics and surgical timing have been widely studied. If the gallbladder polyp is larger than 1 cm, it is better to be treated by surgery first to prevent the occurrence of cancer.
11.How are gallbladder polyps formed?
The manifestations of gallbladder polyp-like lesions include many pathological types, which are classified into two categories: non-neoplastic and neoplastic lesions, and neoplastic lesions are divided into benign and malignant.
1. Non-neoplastic lesions: cholesterol polyps are the most common among them.
(1) cholesterol polyps: cholesterol deposition is an important cause of gallbladder polyps, cholesterol deposited in the macrophages of the lamina propria of the gallbladder mucosa, and gradually protrude to the mucosal surface
The cholesterol deposits in the macrophages of the lamina propria of the gallbladder mucosa gradually protrude to the surface of the mucosa, causing the mucosal epithelium to proliferate and the muscle layer to thicken and form polyps.
(2) Inflammatory polyp: a kind of granuloma caused by inflammatory stimulation.
(3) Adenomatous hyperplasia: a proliferative lesion that is neither inflammatory nor neoplastic, and may become cancerous.
(4) Adenomyoma: There are local changes in the mucosal epithelium, myofibrillar hyperplasia and limited adenomyosis, so it is also known as adenomyosis in medicine.
2. Neoplastic lesions: These lesions are mainly benign adenomas, and malignant mainly gallbladder cancer.
(1) Adenoma: Most of them are single tipped polyps, which can be papillary or non-papillary in shape, and the malignancy rate is about 30%.
(2) Adenocarcinoma: It is divided into papillary type, nodular type and infiltrative type. The first two are bulging lesions with a diameter of <20mm, while the infiltrative type is not a polyp-like lesion of the gallbladder, and most of them have a diameter of
>20mm.
12.Will gallbladder polyps become gallbladder cancer?
Gallbladder polyp is also called gallbladder bulge-like lesion or gallbladder tumor, from the analysis of gallbladder tumor meaning of gallbladder polyp, it can be divided into two kinds of true tumor and pseudotumor. The so-called true tumor refers to the gallbladder polyp caused by the hyperplasia of the gland and muscle layer of the gallbladder itself, which is a kind of gallbladder tumor in the real sense, and the characteristics of such gallbladder polyps are shown in the following table. The so-called pseudotumor refers to cholesterol accumulation and crystallization caused by dysfunction and disorder of liver and gallbladder cleaning, inflammatory hyperplasia caused by chronic inflammation of gallbladder, other proliferative lesions caused by abnormal changes of gallbladder and bile, and the characteristics of such gallbladder polyps are shown in the following table.
Real tumors of gallbladder polyps Pseudotumors of gallbladder polyps
Medical history Generally no history of chronic cholecystitis Most have a history of chronic cholecystitis
Family history, genetic history None None
Discovery process Usually found by physical examination or when uncomfortable
Ultrasound features: solitary, moderately strong echogenic cluster, immobile, large (usually more than 1cm), mostly in the neck of gallbladder, round or round-like shape
Multiple, strong echogenic clusters, immobile, small (usually less than 1 cm), mostly at the base of the gallbladder, irregular in shape
Symptoms Generally asymptomatic Some have symptoms of cholecystitis such as right shoulder and back pain, right upper abdominal distension and pain
Signs Murphysis Syndrom(-) Sometimes Murphysis Syndrom(+)
Complications Usually no complications Sometimes complications such as fatty liver and pancreatitis
Carcinoma coefficient Higher Lower
13.Is there any good treatment for gallbladder cancer in the medical field now?
The treatment of gallbladder cancer mainly includes surgery (radical resection and palliative surgery), radiotherapy and chemotherapy. At present, most of them advocate to adopt a comprehensive treatment mainly based on surgery. Most of the gallbladder cancers seen clinically are in advanced stages, so the current surgical resection rate is very low and the efficacy after resection is also very poor. Therefore, the key to cure gallbladder cancer is to make an accurate and qualitative diagnosis in early stage. Therefore, the key to cure gallbladder cancer is to make accurate and qualitative diagnosis at an early stage, and to implement the correct comprehensive treatment including surgical treatment. Combination of Chinese and Western medicine can improve the efficacy of gallbladder cancer, especially for advanced gallbladder cancer patients with unsatisfactory surgical effect and low sensitivity of chemotherapy, if combined with Chinese medicine, it can improve the general condition of patients and prolong the survival period.
14.What is atrophic cholecystitis?
Due to repeated attacks of cholecystitis caused by gallbladder stones and other reasons, the gallbladder itself gradually forms fibrosis and the physiological function of the gallbladder itself disappears. The gallbladder forms a fibrous tissue with no internal cavity. In severe cases, the atrophied gallbladder forms adhesions with the surrounding organs and tissues, which makes surgical removal very difficult.
15.I have frequent episodes of biliary colic, but it can be relieved by infusion in the hospital, what is the matter?
Biliary colic is a severe cramping pain in the right upper abdomen, radiating to the shoulder and back, accompanied by nausea and vomiting. Sometimes the symptoms disappear due to the change of position and release of the stone; otherwise, fever, peritonitis, shock and other symptoms may occur secondary to infection, septicemia, jaundice and perforation. If surgery is not possible after the onset of biliary colic, simple infusion therapy can usually relieve the symptoms. Because the infusion contains drugs to relieve gallbladder spasm and pain medication, these drugs can temporarily relieve the severe abdominal pain caused by biliary colic. However, these conservative infusion treatments are only symptomatic and only address the pain, but not the underlying factors of the disease. Therefore, many patients will have recurrent biliary colic attacks. The most fundamental treatment option is to perform surgery.