Removal of the gallbladder= prevention of liver cirrhosis?

Ερώτηση

Dear expertteam,
I was wondering about my liver cirrhosis. I was told once, that - when suffering from CF - the reason for a liver cirrhosis could be the gallbladder among ohter reasons. In other words: the bile because this fluid can not flow off due to mucus in the bile duct. This congestion is causing liver damage.
If this is all correct, is it not possible simply to remove the gallbladder, the same procedure you do when you suffer from gallstones? The advantage would possibly be that if there is no gallbladder and therefore no bile anymore there is no congestion of bile in the liver either?!?
Is this idea completely unrealistic?

Many greetings

Απάντηση

Dear questioner,
unfortunately the solution to the problem is not so easy. The bile is produced in the liver and flows off through very little bile channels, which merge to bigger channels leaving the liver over the bile duct. The bile duct leads into the small bowel, where the bile is finally needed. The gallbladder is a small organ which is attached to the bile duct, connected via a small channel. The gall bladder is acting as a reservoir for bile, however one can live without this reservoir.
If the gallbladder would be removed for a certain reason, the liver will continue to produce bile, which is draining over the bile duct into the small bowel. The only difference would be that there is no reservoir anymore. The consequence of this pathophysiology for a CF patient is that the problem of congestion of bile is not solved by removal of the gallbladder. The bile which flows off via the bile duct remains still very "thick" and can cause congestion and damage of the liver.
Therefore a prophylactic removal of the gallbladder is not recommended for CF patients.
There are the same indications to remove the gallbladder for CF or non-CF patients: in case of gallstones (which are more frequent in CF, of course) an operation is only recommended if the stones are causing symptoms (e.g. pain or recurrent inflammation). As any operation always carries a risk to the patient, especially when suffering from CF, the indication for an operation has to be well reflected. Specifically in CF, there is the risk of worsening the pulmonal situation.
In general there is also the possibility to use drugs like ursodeoxycholic acid to improve the flow of the bile and to prevent the congestion of bile that you described in your question. Try to speak with your CF-care team about all these possibilities in detail again.
I hope that I could help you.
Yours sincerely,

Dr. Daniela d'Alquen

31.10.2007