Gallbladder Conditions

Gallbladder disease is very common in the United States. Fortunately, advances in laparoscopic surgical techniques have made it possible for this disease to be treated in a manner that minimizes pain and complications. It also allows most patients to leave the hospital the same day. Patients can expect to return to work within two weeks. Of course Dr. Castillo also provides open (traditional) gallbladder surgery when needed.

The gallbladder is the organ located under your liver and stores bile, which is a fluid made by your liver that helps your body digest fat.

Common gallbladder problems include the following:

• Gallstones: These are usually made of hardened cholesterol. They can range in size from as small as a grain of sand to as large as a golf ball.
• Polyps: These are usually the precursors to gallstones.
• Sludge: An accumulation of particulate matter in the bile.
• Biliary Dyskinesia: This is when the gallbladder does not empty normally.
• Cholecystitis: Inflammation of the gallbladder. This can be caused by gallstones or biliary dyskinesia.

Symptoms

• Pain in the upper right side of the abdomen, frequently radiating to the right shoulder blade-especially after eating fatty meals.
• Excessive gas and bloating after eating fatty meals or eating fresh fruits and vegetables.

Diagnosis
Dr. Castillo employs a number of different minimally invasive tests to diagnose gallbladder conditions:

Abdominal ultrasound: This noninvasive test uses painless sound waves to "look at" the gallbladder. It is the best test to look for gallstones. It can also be used to evaluate the health of the liver and indicate if there are signs of cholecystitis. This test is performed by a radiologist.

HIDA scan with CCK injection (cholescintigraphy): This test indicates how well the gallbladder is functioning. It will also reveal signs of cholecystitis (inflammation of the gallbladder). During a HIDA scan, radioactive dye is injected intravenously. The radiologist is then able to see the dye travel through the bile ducts, into the gallbladder and into the small intestine. How quickly the bile travels and whether or not you have symptoms during the test can help us identify gallbladder problems due to biliary dyskinesia.

Endoscopic retrograde cholangiopancreatography (ERCP): This test is performed by a gastroenterologist. Using a combination of endoscopy and xray, the doctor can evaluate the bile ducts and gallbladder for gallstones or other pathology. A small flexible camera is put through the mouth, into the stomach and then into the small intestine. A tiny catheter is then placed into the bile duct. Dye is injected through the tube, which enables x-rays to visualize the gallbladder and its ducts.

Magnetic Resonance Cholangiopancreatography (MRCP): This test uses an MRI to evaluate the biliary and pancreatic ducts in a non-invasive manner. This procedure can be used to see if there are gallstones lodged in any of the ducts surrounding the gallbladder.

Treatment:

If you do not have gallstones, you may be able to manage your symptoms with dietary modifications. If you have gallstones that are causing symptoms, it is recommended that you have your gallbladder removed "electively" to avoid a possible emergency surgery if any of the stones get stuck in a bile duct. Laparoscopic surgical techniques make it possible to remove the gallbladder with minimally invasive methods that allow for a quicker and less painful recovery.

A Laparoscopic Cholecystectomy is a minimally invasive procedure performed under general anesthesia. Dr. Castillo will make four small incisions on your abdomen through which he will remove the gallbladder. He will also perform an intra-operative cholangiogram. This is where he puts dye into your gallbladder and an x-ray is taken. This helps define the anatomy and will reveal any stones that may be lodged in a duct. A laparoscopic cholecystectomy is typically done as an outpatient procedure and most patients return to work within 2 weeks.

An Open Cholecystectomy is performed as an inpatient procedure under general anesthesia. In this procedure, the gallbladder is removed through a single large incision under the right rib cage. Patients usually stay in the hospital 2 - 4 days and recovery is approximately 6 weeks.