Bile Formation and Normal Gallbladder Function
Bile is the green liquid that is made by the liver and is essential for digesting fat. Without some fat in the diet we would not be able to survive as it is essential for the absorption of fat soluble vitamins, so bile is therefore essential for health. Bile is made by the cells of the liver and is collected within a series of tubes within the liver itself called the bile ducts. These run down into one main tube called the common bile duct which delivers the bile into the gut (duodenum) where it is mixed with the food. Off the common bile duct is a side branch and at the end of the side branch is the gallbladder. Under normal circumstances bile passes straight down the common bile duct into the gut but during fasting, typically, some of the bile is bypassed down the side branch where it is stored within the gallbladder. So in effect the gallbladder acts as a storage organ for the bile and when food is taken in the gallbladder contracts and any bile that is stored within it is forced out down the cystic duct (side branch) and then into the common bile duct, effectively giving a rush of bile to meet with the food as it comes down the duodenum. Why we have this storage facility is not really known because it is in fact surplus to requirement.
Gallstones form because the gallbladder does not contract on a regular basis so in fact it is the gallbladder that is at fault. Failure of the gallbladder to contact means that any bile that is stored within it becomes thickened and glue-like and will eventually crystallise and these crystals then form into gallstones. Any attempts to get rid of the gallstones whilst retaining the gallbladder, is illogical and a lot more difficult to achieve than simply removing the gallstones with the gallbladder itself. As discussed the latter is not required for optimal health and it is this that is the cause of the gallstones in the first place.
Gallstones are common. Many patients have gallstones without realising it and they are often picked up incidentally on scans when investigating other conditions. The majority of patients that have asymptomatic gallstones will remain asymptomatic and on this basis there is no real indication for active treatment. Those patients that do experience problems with their gallstones can present in a few different ways. The typical presentation is biliary colic but they can also present with cholecystitis, ascending cholangitis or pancreatitis. The initial management of all of these conditions is different but the definitive management is largely the same namely elimination of the gallstones by removing the gallbladder itself otherwise known as a cholecystectomy.
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