The gall bladder is a small, pouchlike, green organ located on the undersurface of the right lobe of the liver. It measures 3 to 4 inches (7.6 to 10 centimeters) in length. The gall bladder's function is to store bile, of which it can hold about 1.2 to 1.7 ounces (35 to 50 milliliters).

The liver continuously produces bile. When digestion is not occurring, bile backs up the cystic duct and enters the gall bladder. While holding the bile, the gall bladder removes water from it, making it more concentrated. When fatty food enters the duodenum once again, the gall bladder is stimulated to contract and spurt out the stored bile. The bile assists in digestion of fatty foods.

Gallstones are solid crystal deposits that form in the gall bladder. They can vary in size from as small as a grain of sand to as large as a golf ball. Eighty percent of all gallstones are composed of cholesterol, a fatlike substance produced by the liver. Gallstones form when the liver produces more cholesterol than intestinal juices can liquefy.

Gallstones are the fifth most common reason adults are hospitalized in the United States. They usually develop in adults between the ages of twenty and fifty. The condition of developing gallstones tends to run in families. In addition, high levels of estrogen (female hormones), insulin (hormone that regulates sugar levels), and cholesterol in the body increase the risk of developing gallstones. A diet high in fat and low in fiber, heavy drinking, and smoking may also play a part.

Gallstones may block the common bile duct, preventing bile from flowing into the duodenum. A gallstone in the cystic duct may cause the gall bladder to become inflamed. Symptoms of a gallbladder attack include pain that begins in the abdomen and moves to the chest and back, chills and sweating, nausea and vomiting, and gas and belching.

The most common treatment for cholecystitis (gall bladder inflammation) caused by cholelithiasis (gallstones) is either lithotripsy, ERCP (endoscopic retrograde cholangiopancreatography) or a surgical procedure.

LITHOTRIPSY

Although first used to treat kidney stones, this technique is also useful in eliminating gallbladder obstruction from stones. Doctors use two types, either extracorporeal shock wave lithotripsy (electrical shock waves crush stones) or intracorporeal lithotripsy (ultrasound waves breaks up stones). These are done on an outpatient basis and can provide immediate relief.

ERCP

This procedure allows the doctor to visualize and remove the stones, diagnose and treat. An endoscope is inserted through the mouth and guided internally through stomach to the bile duct where a stone can be crushed and extracted by a tool inside the scope.

Laparoscopic cholecystectomy- Most common surgical procedure for gallstones and obstruction. Four small incisions are made and carbon dioxide gas is pumped into the abdominal cavity to inflate it. Next the gallbladder is visualized through a laparascope and the gallbladder is completely removed through the one of the small incisions. A patient can be discharged within 24 hours if there are no complications. My wife had this surgery in 2003 while she was pregnant with our second child and her main complaint was the intense pain in her right shoulder due to the migration of the carbon dioxide gas migration. My wife's complaint is the most common complaint of all patients undergoing this procedure.

Laparoscopic Laser Cholecystectomy- Very similar to the above procedure except that a laser is used to make four small puncture wounds through the skin of the abdomen instead of traditional surgical instruments.

Choledochostomy or Choledochotomy- This procedure involves making an artificial passage through the abdominal wall and into the common bile duct in order to remove gallstones. When a choledochotomy is done, there is an incision directly into the common bile duct for stone removal.

Abdominal or "Open" cholecystectomy- Prior to the development of the "Lap Chole" procedure, abdominal cholecystectomy was the traditional procedure for gallstone removal. This involves a large, open incision in the abdomen with the surgeon reaching in and taking out the gallbladder through the large incision. This is not used much today, except with morbidly obese patients.

If you do have your gallbladder removed, it is recommended to not eat fatty foods for a couple of months. It is also recommended that people avoid gas-producing foods like soda pop, cabbage and onions (there are many more, these are just examples). Not to be the bearer of bad news, but both my mother-in-law and wife have had their gallbladders removed and to this day, they have trouble digesting certain foods including fried foods, popcorn and some vegetables. They both tell me that they would take the altered G.I. tract any day over the intense pain of the gallbladder attacks they experienced.