GALLBLADER BASICS
GALLBLADER BASICS
Copyright 2007, Samos Alixopulos, RN
What's a gallbladder anyways?
The Gallbladder is basically a very handy sack that the body uses to store [extra] bile.*
*So what the heck is bile?
Bile is that yellowish-greenish stuff we frequently see coming out of the NGT. However, it is not produced by the NGT, it is produced by the Liver. It travels through little tubes (canals) and into the "common bile duct," where it then either goes into the small intestine, or into the gallbladder to be saved for later.
Bile is essentially a yucky juice that helps us digest fat. It is primarily made up of cholesterol, [bile] acids (AKA bile salts), and bilirubin (which is produced during the breakdown of RBCs).
There are primarily two problems people have with their gallbladder:
1). Gallstones (cholelithiasis). This you might expected with all those salts and acids...
2). Inflamation (cholecystitis). Usually caused by the stones, which are, like duh, irritating. But, having too much fun (ETOH) and systemic illness can also cause the gallbladder to become irritated. Tumors are rare...
What's wrong with a little inflamation?
When the in/out door of the gallbladder becomes too inflamed, bile gets trapped. The pissed off gallbladder is then more susceptible to inflamation, infection, and rupture (a bad thing). The most common symptom is abdominal pain in the RUQ right after a fatty meal, and an elevated temp if there is an infection. Nausea and vomiting is not very common with gallbladder disease, but if you're floating to another unit, it might be severe...
Diagnostic tests include:
- Abdominal ultrasound, CT scan, and AbdXR.
- Oral cholecystogram: A fancier AbdXR taken in a series with dye. The pt. may also get to have a high-fat drink in the middle of this series to stimulate the gallbladder into producing bile for the camera.
- Gallbladder radionuclide scan. During this test the pt. gets a radioactive IV bolus of chemicals, and then a special camera takes groovy glow in the dark pictures. Sounds fun, huh?
- ERCP. Endoscopic Retrograde CholangioPancreatography. Its a special endoscope with a little XR camera at the end of it. With direct visualization the docs can inject dye right into the bile ducts for superior visualization (Ohm...).
- CBC to check for elevated WBCs...
Treatment:
Occassionally, patients will get lucky and can be treated with just ABOs, analgesics, and boring, low-fat food. Removal of the gallstones can buy some time, but only if the patient doesn't fall off the veggie wagon...
Time for surgery!
Most gallbladder problems are resolved without mercy... The gallbladder is simply sucked out of the patient's body through an oversized straw! This is called a laporoscopic cholecystectomy... Its a great source of income for hospitals all around the country..
An emergent "open chole" may be necessary if perforation, pancreatitis, necrosis, or inflammation of the common bile duct occurs. BUT, if the patient is too sick to have surgery right away, a cholystostomy tube (a.k.a. T-Tube) may be placed to relieve the gallbladder of bile temporarily. This may also be neccessary if the patient waits until Friday to enter the hospital system (as surgeons often have other priorities during the weekend).
Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and of course, the boring low-fat diet.
After surgery, most people forget they ever had a gallbladder...
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