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The gallbladder is a sac-like organ that is located under the liver. Its main function is to store and concentrate bile, which is a digestive fluid that is produced by the liver. Bile comprises bile pigment, bile salts, and cholesterol. Bile flows through tiny ducts, which carry bile from the liver. The cystic duct lies between the gallbladder and the common bile duct (duct that is formed by the union of the cystic duct and the common hepatic duct). The common hepatic duct is formed by the union of the left and right hepatic ducts. Bile from the liver is carried by the common hepatic duct into the common bile duct, which in turn conveys bile into the duodenum. A sphincter is located at the entrance of the duodenum. This muscle stays contracted, thereby allowing bile to collect in the common bile duct, and back up into the cystic duct. Bile enters through the cystic duct into the gallbladder, where it is stored. When bile is needed, the sphincter relaxes, and bile flows through the common bile duct into the duodenum.

If the concentration of cholesterol or bile pigments is higher than normal, these could crystallize to form stone-like, hardened deposits called gallstones. The presence of gallstones in the gallbladder is referred to as cholelithiasis. If the gallstones are large, these can block the ducts that carry bile from the gallbladder to the small intestine. This results in the inflammation of gallbladder, which is medically referred to as cholecystitis.

Gallstones in Pediatric Population

Cholecystitis could be acute or chronic. Acute cholecystitis is characterized by a sudden sharp pain in the upper right section of the abdomen. It occurs when bile gets trapped in the gallbladder due to the blockage of the cystic duct by a gallstone. The buildup of bile in the gallbladder causes irritation, inflammation, and pressure in the gallbladder. This also make one susceptible to swelling and infection. In rare cases, the inflammation could be a complication of a tumor, diabetes, or HIV. When the blockage occurs repeatedly, it is referred to as chronic cholecystitis. The bladder gets damaged due to repeated attacks of acute inflammation. As a result, the walls of the gallbladder might become thick and scarred. About 40% of all pediatric cases of chronic cholecystitis occur in children below 11 years of age, and 60% occur in children in the age group of 11 to 20 years. A serious form of acute cholecystitis is acalculous cholecystitis, which is characterized by acute inflammation of the gallbladder in the absence of gallstones.

Children normally develop black pigment, cholesterol, calcium carbonate, protein dominant, or brown pigment stones. Black pigment stones, which are formed when bile becomes supersaturated with calcium bilirubinate (the calcium salt of unconjugated bilirubin), constitute 48% of gallstones in children. Brown pigment stones being rare, account for only 3% of gallstones in children, and are made of calcium bilirubinate and the calcium salts of fatty acids. They are more likely to occur in the bile ducts than in the gallbladder. Calcium carbonate stones, which are rare in adults but common in children, account for 24% of stones in children. The remaining protein-dominant stones account for only 5%.

Symptoms

The onset of the symptoms of gallbladder disease is sudden. Also, it is not very easy to detect. However, some of the common symptoms of gallstones in pediatric population include:

Pain
Pain is experienced in the upper right side of the abdomen. It might peak after 15 to 60 minutes, and persist until the attack is over. The attack may last for a very long time, normally from 6-12 hours. The pain can also be felt in the shoulder and back.

Fever
The child may gradually develop fever that tends to rise above 100.4°F (38°C). The fever might be accompanied by chills. Studies show that this symptom develops in about one third of children with acute cholecystitis.

Other Signs and Symptoms
The symptoms are most likely to appear after meals, especially when one consumes food items that are rich in fat. The affected child might experience the following symptoms:

Nausea
Vomiting
Indigestion
Gas
Bloating
Burping
Belching especially after meals

Underlying Causes or Risk Factors

Various contributing factors that can lead to gallbladder problems in children include:

Impaired immune system
History of abdominal surgery
Prolonged parenteral nutrition
Hemolytic disease; lysis or destruction of erythrocytes (red blood cells) with the release of hemoglobin
Hepatobiliary disease, a chronic liver disease that affects the liver or biliary tract
Obesity and trauma
Acute renal failure
Prolonged fasting
Low calorie diet
Prolonged use of certain medications

On a concluding note, medical assistance must be immediately sought, if a child has been experiencing any of the aforementioned symptoms. In severe cases, the surgical removal of the gallbladder might be recommended.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.