Editing Gallbladder (section)

==Clinical significance==
{{Main|Gallbladder disease}}

===Gallstones===
{{Main|Gallstones}}
[[File:Gallbladder stones.jpg|thumb|left|3D still showing gallstones]]
[[Gallstone]]s form when the bile is [[Saturated solution|saturated]], usually with either [[cholesterol]] or [[bilirubin]].<ref name="MSDGallstones">{{cite web|title=Cholelithiasis - Hepatic and Biliary Disorders - MSD Manual Professional Edition|url=http://www.msdmanuals.com/en-au/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/cholelithiasis|website=MSD Manual Professional Edition|access-date=18 October 2017|language=en-AU}}</ref> Most gallstones do not cause symptoms, with stones either remaining in the gallbladder or passed along the [[hepatobiliary system|biliary system]].<ref name=DAVIDSONS2010 /> When symptoms occur, severe "colicky" pain in the upper right [[quadrant (abdomen)|quadrant]] of the abdomen is often felt.<ref name="MSDGallstones" /> If the [[cholelithiasis|stone blocks the gallbladder]], inflammation known as [[cholecystitis]] may result. If the stone lodges in the biliary system, [[jaundice]] may occur; if the stone blocks the [[pancreatic duct]], [[pancreatitis]] may occur.<ref name=DAVIDSONS2010 /> Gallstones are diagnosed using [[ultrasound]].<ref name="MSDGallstones" /> When a symptomatic gallstone occurs, it is often managed by waiting for it to be passed naturally.<ref name=DAVIDSONS2010 /> Given the likelihood of recurrent gallstones, surgery to remove the gallbladder is often considered.<ref name=DAVIDSONS2010 /> Some medication, such as [[ursodeoxycholic acid]], may be used; [[lithotripsy]], a non-invasive mechanical procedure used to break down the stones, may also be used.<ref name=DAVIDSONS2010 />

===Inflammation===
{{Main|Cholecystitis}}
Known as [[cholecystitis]], inflammation of the gallbladder is commonly caused by obstruction of the duct with gallstones, which is known as [[cholelithiasis]]. Blocked bile accumulates, and pressure on the gallbladder wall may lead to the release of substances that cause inflammation, such as [[phospholipase]]. There is also the risk of bacterial infection. An inflamed gallbladder is likely to cause sharp and localised pain, fever, and tenderness in the upper, right corner of the abdomen, and may have a positive [[Murphy's sign]]. Cholecystitis is often managed with rest and antibiotics, particularly [[cephalosporin]]s and, in severe cases, [[metronidazole]]. Additionally the gallbladder may need to be removed surgically if inflammation has progressed far enough.<ref name=DAVIDSONS2010>{{cite book |editor=Nicki R. Colledge |editor2=Brian R. Walker |editor3=Stuart H. Ralston |title=Davidson's principles and practice of medicine|year=2010|publisher=Churchill Livingstone/Elsevier|location=Edinburgh|isbn=978-0-7020-3085-7|pages=977–984|edition=21st}}</ref>

===Gallbladder removal===
{{Main|Cholecystectomy}}
A [[cholecystectomy]] is a procedure in which the gallbladder is removed. It may be removed because of recurrent gallstones and is considered an [[Elective surgery|elective procedure]]. A cholecystectomy may be an [[open surgery|open]] procedure, or a [[laparoscopic]] one. In the surgery, the gallbladder is removed from the neck to the fundus,<ref name="pmid17761085">{{cite journal | author=Neri V | author2=Ambrosi A | author3=Fersini A | author4=Tartaglia N | author5=Valentino TP | title=Antegrade dissection in laparoscopic cholecystectomy | journal=Journal of the Society of Laparoendoscopic Surgeons | volume=11 | issue=2 | pages=225–8 | year=2007 | pmid=17761085 | pmc=3015719 }}</ref> and so bile will drain directly from the liver into the [[biliary tree]]. About 30 percent of patients may experience some degree of [[indigestion]] following the procedure, although severe complications are much rarer.<ref name=DAVIDSONS2010 /> About 10 percent of surgeries lead to a chronic condition of [[postcholecystectomy syndrome]].<ref>nhs.uk, [http://www.nhs.uk/Conditions/Laparoscopiccholecystectomy/Pages/Riskspage.aspx Complications of a gallbladder removal]</ref>

===Complication===
{{main|Biliary injury|Biloma}}
Biliary injury (bile duct injury) is the traumatic damage of the [[bile ducts]]. It is most commonly an [[iatrogenic]] complication of [[cholecystectomy]] — surgical removal of [[gall bladder]], but can also be caused by other operations or by [[major trauma]]. The risk of biliary injury is more during laparoscopic cholecystectomy than during open cholecystectomy. Biliary injury may lead to several complications and may even cause death if not diagnosed in time and managed properly. Ideally biliary injury should be managed at a center with facilities and expertise in [[endoscopy]], [[radiology]] and surgery.<ref>{{citation | author=VK Kapoor | title=Bile duct injury repair: when? what? who? | journal=Journal of Hepato-Biliary-Pancreatic Surgery | year=2007 | volume=14 | issue=5 | pages=476–479 | pmid=17909716 | doi=10.1007/s00534-007-1220-y}}</ref>

Biloma is collection of [[bile]] within the [[abdominal cavity]]. It happens when there is a bile leak, for example after surgery for removing the gallbladder ([[laparoscopic cholecystectomy]]), with an incidence of 0.3–2%. Other causes are biliary surgery, [[liver biopsy]], [[abdominal trauma]], and, rarely, spontaneous perforation.<ref>{{cite book |last=Dolan |first=R.D. |last2=Storm |first2=A.C. |last3=Thompson |first3=C.C. |chapter=Endoscopic management of acute biliary & pancreatic conditions |chapter-url=https://accessmedicine.mhmedical.com/content.aspx?bookid=3204&sectionid=266864223 |editor-last=Friedman |editor-first=S. |editor2-last=Blumberg |editor2-first=R.S. |editor3-last=Saltzman |editor3-first=J.R. |title=Greenberger's CURRENT Diagnosis & Treatment Gastroenterology, Hepatology, & Endoscopy |publisher=McGraw Hill Education |edition=4e |date=2022 |isbn=978-1-260-47343-8 }}</ref>

===Cancer===
{{main|Gallbladder carcinoma}}
Cancer of the gallbladder is uncommon and mostly occurs in later life. When cancer occurs, it is mostly of the glands lining the surface of the gallbladder ([[adenocarcinoma]]).<ref name=DAVIDSONS2010 /> Gallstones are thought to be linked to the formation of cancer. Other risk factors include large (>1&nbsp;cm) [[gallbladder polyp]]s and having a highly calcified [[porcelain gallbladder|"porcelain" gallbladder]].<ref name=DAVIDSONS2010 />

Cancer of the gallbladder can cause attacks of biliary pain, yellowing of the skin ([[jaundice]]), and weight loss. A large gallbladder may be able to be felt in the abdomen. [[Liver function test]]s may be elevated, particularly involving [[Gamma-glutamyltransferase|GGT]] and [[Alkaline phosphatase|ALP]], with ultrasound and CT scans being considered [[medical imaging]] investigations of choice.<ref name=DAVIDSONS2010 /> Cancer of the gallbladder is managed by removing the gallbladder, however, {{as of|2010|alt=as of 2010|post=,}} the prognosis remains poor.<ref name=DAVIDSONS2010 />

Cancer of the gallbladder may also be found incidentally after surgical removal of the gallbladder, with 1–3% of cancers identified in this way. [[Gallbladder polyp]]s are mostly benign growths or lesions resembling growths that form in the gallbladder wall,<ref>{{cite web|title=Gallbladder Polyps|url=http://www.mayoclinic.com/health/gallbladder-polyps/AN01044|website=MayoClinic|access-date=March 19, 2015}}</ref> and are only associated with cancer when they are larger in size (>1&nbsp;cm).<ref name=DAVIDSONS2010 /> Cholesterol polyps, often associated with [[Cholesterolosis of the gallbladder|cholesterolosis]] ("strawberry gallbladder", a change in the gallbladder wall due to excess [[cholesterol]]<ref>[http://cancerweb.ncl.ac.uk/cgi-bin/omd?strawberry+gallbladder Strawberry gallbladder] – cancerweb.ncl.ac.uk.</ref>), often cause no symptoms and are thus often detected in this way.<ref name=DAVIDSONS2010 />

===Tests===
[[File:Ultrasonography of sludge and gallstones, annotated.jpg|thumb|[[Abdominal ultrasonography]] showing [[biliary sludge]] and [[gallstone]]s]]
Tests used to investigate for gallbladder disease include [[blood tests]] and [[medical imaging]]. A [[full blood count]] may reveal an increased white cell count suggestive of inflammation or infection. Tests such as [[bilirubin]] and [[liver function tests]] may reveal if there is inflammation linked to the biliary tree or gallbladder, and whether this is associated with inflammation of the liver, and a [[lipase]] or [[amylase]] may be elevated if there is [[pancreatitis]]. Bilirubin may rise when there is obstruction of the flow of bile. A [[CA 19-9]] level may be taken to investigate for cholangiocarcinoma.<ref name=DAVIDSONS2010 />

An [[ultrasound]] is often the first [[medical imaging]] test performed when gallbladder disease such as gallstones are suspected.<ref name=DAVIDSONS2010 /> An [[abdominal X-ray]] or [[CT scan]] is another form of imaging that may be used to examine the gallbladder and surrounding organs.<ref name=DAVIDSONS2010 /> Other imaging options include MRCP ([[magnetic resonance cholangiopancreatography]]), [[Endoscopic retrograde cholangiopancreatography|ERCP]] and percutaneous or intraoperative [[cholangiography]].<ref name=DAVIDSONS2010 /> A [[cholescintigraphy]] scan is a [[nuclear imaging]] procedure used to assess the condition of the gallbladder.<ref>{{cite web|title=HIDA scan - Overview|url=https://www.mayoclinic.org/tests-procedures/hida-scan/home/ovc-20200578|website=Mayo Clinic|access-date=18 October 2017|language=en}}</ref>