American Medical Association Family Medical Guide - American Medical Association [523]
A more common problem develops when a stone blocks the cystic duct (the tube that carries bile to and from the gallbladder) and causes inflammation in the gallbladder. Having gallstones also increases the risk of acute pancreatitis (see page 798) if a gallstone gets stuck in the pancreatic duct, which drains into the bile duct.
Diagnosis
If you have severe pain resembling biliary colic, your doctor will examine you and question you about the pain. If the doctor suspects that you may have gallstones, he or she will probably order an ultrasound scan (see page 111) of the abdominal area to detect and locate any stones. You will have blood tests to measure liver proteins to help evaluate the functioning of your liver. You may also have a hepatobiliary (HIDA) scan, a test that can detect a gallbladder obstruction by tracking a radioactive dye through your liver and gallbladder. In HIDA, a nuclear scanner takes multiple pictures of your abdominal area, and a radiologist (a doctor who specializes in the use of radiation for medical diagnosis or treatment) interprets the pictures.
Treatment
If you are having severe pain from a gallstone, your doctor may give you an injection of a strong pain reliever to reduce the pain immediately. If tests show that you have gallstones in your bile duct, the doctor will recommend that you have them removed. One of several procedures will be performed, depending on your condition and the location of the stones. Gallstones are frequently removed in a procedure called laparoscopic cholecystectomy (see next page), which is performed through small incisions in the abdomen. In rare cases (for people who are very ill), more extensive surgery that opens the abdomen is performed in which an incision is made in the bile duct and the stone is removed directly from the duct. In both of these procedures, the gallbladder is also removed to avoid the risk of more stones forming.
Primary Sclerosing Cholangitis
Primary sclerosing cholangitis is inflammation and scarring of the bile ducts inside and outside the liver. The bile ducts carry bile out of the liver into the small intestine, where it helps break down fats from food. As the scarring builds up in the bile ducts, it can block the ducts, causing bile to accumulate in the liver, damaging liver cells. Over time, the condition can cause liver failure.
The cause of primary sclerosing cholangitis is unknown, but doctors think it involves a faulty immune response triggered by an infection. Between 70 and 80 percent of people who have primary sclerosing cholangitis also have an underlying inflammatory bowel disease (usually ulcerative colitis; see page 764). Primary sclerosing cholangitis usually begins between ages 30 and 60 and is more common in men than in women.
Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy is a common procedure used to remove the gallbladder. It can usually be done through four small incisions in the abdomen using a laparoscope (viewing tube). After determining the number of gallstones and their location using an imaging procedure such as ultrasound, the surgeon inserts the laparoscope through one of the incisions. The laparoscope’s fiberoptic viewing system transmits a clear image of the abdominal cavity onto a video monitor. The surgeon then passes tiny precision instruments through the laparoscope or through the abdominal incisions to remove any gallstones.
The surgeon puts clips on the cystic artery and the cystic duct to close them off and takes an X-ray to look for any hidden stones in the common bile duct. He or she then uses tiny scissors to free the gallbladder from the artery and duct, and removes the gallbladder through a tiny incision below the navel.
During the cholecystectomy, which is commonly done on an outpatient basis, the person is under general anesthesia. The procedure usually takes less than an hour, recovery is relatively quick, and the incisions rarely leave noticeable