The gallbladder and bile ducts play crucial roles in fat digestion and bile transport. Disorders affecting these structures can cause significant symptoms and complications requiring prompt recognition and treatment.

• Gallstones

Formation and Types

Gallstones form when bile components precipitate within the gallbladder. Cholesterol stones are most common in Western populations, while pigment stones occur more frequently in patients with haemolytic disorders or biliary infections.

Symptoms

Many gallstones remain asymptomatic throughout life. Symptomatic stones typically cause biliary colic – severe, constant right upper quadrant pain that may radiate to the back or shoulder. Episodes often follow fatty meals and can last several hours.

Complications

Complications include acute cholecystitis, choledocholithiasis (stones in bile ducts), gallstone pancreatitis, and rarely, gallbladder perforation. These conditions require urgent medical attention and often surgical intervention.

Treatment

Asymptomatic gallstones typically require no treatment. Symptomatic stones are usually managed with laparoscopic cholecystectomy, which provides definitive treatment with minimal invasiveness. Medical dissolution therapy is rarely used due to limited efficacy and high recurrence rates.

• Primary Sclerosing Cholangitis

Disease Characteristics

Primary sclerosing cholangitis is a chronic inflammatory condition causing progressive fibrosis and stricturing of bile ducts. The disease often associates with inflammatory bowel disease, particularly ulcerative colitis.

Symptoms

Early disease may be asymptomatic, with abnormal liver tests providing the first indication. Progressive disease causes fatigue, pruritus, jaundice, and eventually complications of portal hypertension and liver failure.

Diagnosis

Magnetic resonance cholangiopancreatography (MRCP) or ERCP reveals characteristic bile duct changes including multifocal strictures and dilatations creating a “beaded” appearance. Liver biopsy may show supportive changes but is not diagnostic.

Treatment

No specific treatment halts disease progression. Management focuses on complications including bile duct strictures, infections, and fat-soluble vitamin deficiency. Liver transplantation represents definitive treatment for end-stage disease. Regular surveillance monitors for cholangiocarcinoma development.