Post Number 7: It's Like Trying To Squeeze a Golf Ball Through a Straw

Gallstones in the gallbladder

        Hello everyone! I hope you all had a great week. I just wanted to say thank you for reading my blogpost, I really appreciate that you take the time to check out the things I learn in the ER. Without further ado, here is my post:

     Our digestive system is a messy and intricate system that is too complicated for me to cover in one post so today, I am going to focus mainly on the gallbladder. One of the most common health issue in the United States is Gallstones.The gallbladder, located on the right side of the body, is a small, greenish organ tucked into the curve of the liver. The purpose of the gallbladder is to store excess bile. After we eat, a little bit of bile is released from the gallbladder and passed through the cystic duct (the “neck” of the gallbladder). After that, the bile goes through the duct into the duodenum of the small intestine. It is in the duodenum that the bile mixes with the chyme (mushed up food essentially that comes out of the stomach). Through emulsification, large fat molecules are broken down with lipase (one of the enzymes in the pancreatic juice) into micelles (little droplets of fat. Woah. I Know). Because oil doesn’t mix with water, bile (a type of emulsifier) is needed to ‘carry’ the fat through the fluid bloodstream so the fat doesn’t solidify. 

            When there is an excess of chemicals in the gallbladder like cholesterol, calcium bilirubinate, or calcium carbonate, Gallstones can form. Gallstones (the medical term: Choledocholithiasis) are extremely common as a result because the chemicals listed above reside in the gallbladder already and gallstones can form over time from factors like age, sex and ethnic origin. These gallstones can block the bile duct or duodenum and keep these chemicals bottled up within the structure. The best way to visualize how a gallstone blocks the bile duct is thinking of trying to squeeze a golfball through a straw (ouch ouch ouch).

            In terms of checking for gallstones, an ultrasound is one of the first procedures to be done. Because sound waves are reflected off of the gallstones, the gallstones are lit up brightly while the structure of the gallstone is slightly shadowed.  Other procedures used to identify gallstones are more invasive. When using an x-ray to identify gallstones, a dye is injected to bloodstream where it will collect in the bile duct or gallbladder. After an x-ray is taken, the dye will show on the photos and confirm gallstones.  Another procedure that can be done to identify gallstones are CT scans, which use radiation to take cross-section images of the patient’s body. Because ultrasounds are the least invasive, most time effective procedure, ultrasounds are almost always the first imaging tool used to diagnose internal issues like gallstones.

            If gallstones are not removed, the gallstone can block the bile duct of the gallbladder and cause jaundice(when the skin and white part of the patient’s eyes turn yellow),cholecystitis (swelling of the gallbladder) or acute pancreatitis (when the buildup of enzymes start to digest the tissue of the pancreas causing swelling, bleeding and organ damage).  

            Usually, gallstones are removed through surgery and sometimes, even the gallbladder itself is removed. Fortunately, if the gallbladder is removed, our digestive system can recover quickly and continue to function with the remaining enzymes produced by the liver. If the gallstones are smaller, they can pass through the body naturally or be dissolved through over the counter medication.

            Now that I’ve explained how gallstones are formed, I will show a few ultrasound images that show gallstones.

Ultrasound image of a gallstone. the rock is bright and the area around it is shadowed.
          

X-ray image of gallstones (Not as easy to spot huh? Was this image worth injecting dye into your body? I don't think so.)

A gallstone. (Now do you get the image of  trying to pass a golf ball through a straw? There is no way that huge gallstone can go through your bile duct. *shudders*)