Disorders of the Gallbladder and Bile Ducts

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Disorders of the Gallbladder and Bile Ducts
The liver secretes bile, which passes via the two hepatic ducts into the common hepatic duct. The common hepatic duct runs for 1.5 inches before being joined by the cystic duct coming from the gallbladder. Before bile continues its journey through the common bile duct into the intestinal tract, it must flow into the gallbladder. The gallbladder is a pear-shaped pouch that protrudes from the bile duct. It is attached to the posterior side of the liver.

A normal gallbladder generally holds about two fluid ounces of bile. The bile in the gallbladder, however, is not in the same form as it was when it left the liver. In the gallbladder there is such a great active reabsorption of salt and water that the volume of bile is reduced to only one tenth of its original quantity. Bile salts are not absorbed, which means, their concentration is increased by about ten times. However, mucus is added to the bile, which turns it into a thick mucus-like material. Its high concentration makes bile the powerful digestive fluid it is.

The muscular walls of the gallbladder contract and eject bile when acid food and protein products enter the duodenum from the stomach. A more marked activity is noted if food entering the duodenum contains a high proportion of fat. The bile salts in the bile are used to emulsify the fat and facilitate its digestion. Once the bile salts have done their job and left the emulsified fat for intestinal absorption, they travel on down the intestine. Most of the bile salts are reabsorbed in the final section of the small intestine and carried back to the liver. There it is collected again in the bile and secreted into the duodenum. (Note: Intestinal congestion sharply reduces the amount of bile salts needed for proper bile production and fat digestion.)

Gallstones can cause irritation and inflammation of the lining of the gallbladder, as well as the cystic and common bile ducts. This condition is known as cholecystitis. There may also be superimposed microbial infection. Ulceration of the tissues between the gallbladder and the duodenum or colon, with fistula formation and fibrous adhesions, is not uncommon. Gallbladder disease generally originates in the liver. When liver lobules become structurally distorted due to presence of gallstones and, eventually, fibrous tissue, venous blood pressure starts to rise in the portal vein. This, in turn, increases the blood pressure in the cystic vein that drains venous blood from the gallbladder into the portal vein. The incomplete elimination of waste products through the cystic duct causes a backup of acidic waste in the gallbladder tissue. This gradually reduces the performance of the gallbladder. The formation of gallstones is just a matter of time.

From Andres Moritz

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