The gallbladder is a small pouch that is attached by a tube to the bile duct leaving the liver.  It serves as a storage area for bile, such that when a child eats, there is a ready supply of bile to help with digestion.  Sometimes the fluid that collects in the gallbladder can become a thick sludge or hard stones.  If the stones are small enough to fit through the exit tube, they can travel down the tube and get stuck... most often right where the tube empties into the small intestines.  This can block bile and pancreatic juices leading to inflammation, pain, vomiting, fever and jaundice.  If this obstruction is not corrected, the child can become extremely ill.  Sometimes surgery or an endoscopic procedure is necessary to remove the obstruction.

 

What are gallstones?

Gallstones are collections of minerals, bile and cholesterol than form hard stones in the gallbladder.  The reason gallstones form is not entirely known, however poor emptying of the gallbladder and an excess of cholesterol or other stone-forming substance likely plays a role.  Some stones will crumble when held and others are literally hard as a rock.

When are gallstones a problem?

Large and medium sized gallstones can form over years and frequently cause no symptoms.  Small gallstones that can exit the gallbladder and get stuck in the bile duct are a problem.  Blockage of bile and pancreatic juices can make a child extremely ill.  Some gallstones irritate the inside of the gallbladder and can help lead to an infection of the gallbladder (cholecystitis).

What are the symptoms of a bile duct blockage?

• Abdominal pain in the right upper abdomen
• Fever
• Jaundice
• Nausea and vomiting
• Sometimes pain can be felt in the right shoulder blade area (referred pain)

How are gallstones diagnosed?

The best study for diagnosing gallstones is an ultrasound.  This test can see most gallstones and can also help determine if the bile ducts are blocked (blocked bile ducts become dilated from the buildup of pressure).

How are gallstones treated?

Gallstones do not need to be treated unless they are irritating the gallbladder (most don't) or are causing a blockage in the bile duct.  The treatment for a blocked bile duct is either endoscopic retrograde cholangiopancreaticography (ERCP) or a intraoperative cholangiogram.  The gallbladder is usually removed (cholecystectomy).  The best time to remove the gallbladder after an obstucting gallstone is controversial, however if ERCP removes the obstruction, the gallbladder can be removed at a later date.