GALLBLADDER AND BILIARY TRACT
SPECIAL FIELD GALL
The gallbladder is a hollow organ in the upper right part of the abdomen and has the function of storing and concentrating the bile generated by the liver. Bile is needed for digesting fats in the intestines and, together with the normal bile flow, is released from the gallbladder into the duodenum.
The biliary tract (bile ducts) are vessels that transport bile from the liver to the gallbladder and the intestine (duodenum). A distinction is made between the intrahepatic (situated within the liver) and extrahepatic (situated outside the liver) bile ducts.
A frequent disease of the gallbladder are gallstones (cholelithiasis); an inflammation of the gallbladder (cholecystitis) is less common. A typical symptom is the biliary colic that occurs when a gallstone (concrement) coming from the gallbladder temporarily obstructs the cystic duct. Stones in the common bile duct (choledocholithiasis) are less common.
OBSTRUCTION OF THE BILE FLOW (CHOLESTASIS)
If the efferent bile ducts are blocked, an obstruction of the bile flow (cholestasis) occurs. A typical symptom is yellowness of the skin and the whites of the eyes (icterus, jaundice), urine which is brownish in colour and discolouration (grey-white) of the stools. Cholestasis may, depending on the cause of the obstruction of the bile flow, be associated with pain, but not necessarily.
Any pathological changes of the gallbladder and bile duct have to be identified and treated. Sometimes a tumour growing from the gallbladder or bile duct may be the origin of symptoms, so an exact diagnosis and the distinction between a stone, inflammation and a tumour is a must for proper treatment.
Gallstones and cholecystitis
Mostly, gallstones develop under certain conditions in the gallbladder (cholecystolithiasis), more rarely they are found in the common bile duct (cholelithiasis, choledocholithiasis). In the majority of people, gallstones go unnoticed for many years. In some cases, recurring symptoms can be observed, such as pressure or aching in the upper right abdominal area which get worse after eating and subside again afterwards.
A typical, acute symptom is biliary colic. This is characterised by intense spasms in the upper abdomen which come and go in waves, sometimes for hours. In some cases, the pain gets worse and is ongoing and accompanied by a high temperature and a feeling of being unwell. In such cases, additional inflammation of the gallbladder (cholecystitis) is often present.
Gallstones involve the risk of complications (inflammation, obstruction of the bile flow) and should therefore be treated in good time. Asymptomatic gallstones can, as long as they have never caused any problems, simply be kept under observation. There is, however, no guarantee that these stones will not become symptomatic at some point in time (maybe at an inconvenient time) or even cause complications right away.
Inflammation (cholecystitis) may get worse and lead to purulent necrosis of the tissue of the gallbladder along with perforation and peritonitis. Stones in the gallbladder (in particular if they are smaller than one centimetre) can migrate from the gallbladder to the common bile duct and cause an obstruction of the bile flow (cholestasis, obstructive jaundice, icterus) and lead to acute inflammation of the pancreas (biliary pancreatitis).
Secondary diseases resulting from gallstone complications can be life-threatening and require fast and targeted medical and/or surgical treatment.
Treatment of gallstones today
For the treatment of gallstones, the removal of the gallbladder by keyhole surgery (laparoscopic cholecystectomy) is recommended nowadays. This operation method means that only the gallbladder with the stones is removed. The bile ducts, which carry the bile from the liver to the digestive tract, remain intact. This operation has no effects on eating behaviour or digestion in the future, and there are no post-operative limitations such as a special diet. Surgery is performed under general anaesthesia; the stay in hospital is short, usually 2-3 days. Recovery will be quick after surgery.
I would be pleased to advise you comprehensively on appropriate methods of diagnosis and the treatment of gallstones and will, if an operation is necessary, perform it safely and in a competent way.
Gallbladder cancer and tumours of the bile duct, Klatskin tumours
Sometimes an obstruction of the bile flow (cholestasis) including yellowness of the skin and the whites of the eyes (jaundice, icterus), brownish urine and discolouration (grey-white) of the stools may be the first symptoms indicating the presence of a tumour of the bile duct or the gallbladder. A tumour growing right at the confluence of the right and left hepatic bile ducts is called a Klatskin tumour.
An exact diagnosis and distinguishing between stones, inflammation and a tumour is a must for proper treatment. A contrast-enhanced CT scan (CT), magnetic resonance imaging (MRI) and, if necessary, an endoscopic retrograde cholangiography (ERCP) are important examination methods for the exact clarification of the type and extent of this disease.
I am pleased to advise you on appropriate diagnostic methods and treatment and will perform a necessary operation safely and in a competent way.
Follow-up of gallbladder bile duct cancer
In order to detect a recurrence of the disease in time or discover concomitant diseases follow-up examination is necessary and useful.
Regular examinations give you the assurance that everything is alright.
During the first two years after surgery, the intervals between follow-up visits are short, usually every three months. The intervals are extended thereafter to six months, and finally to once a year. After five years, you can change the regular follow-up on a symptom-oriented follow-up.
The tests usually include:
- Physical examination, body weight and size
- Talking about the current condition and current complaints
- Blood laboratory: values for kidney, liver and bile degradation products
- Tumor markers in the blood: CEA and CA 19-9
- Contrast-enhanced computed tomography (CT) of the lungs and abdomen
- If necessary: Magnetic resonance imaging of the liver
Sometimes additional tests are required. I am happy to organize the follow-up for you and discuss the obtained findings with you.