An overactive gallbladder, also known as hyperkinetic gallbladder, refers to a condition where the gallbladder contracts excessively and frequently without appropriate stimulation. This happens when the smooth muscle within the gallbladder, known as the muscular layer, becomes overly sensitive to certain gastrointestinal hormones, particularly cholecystokinin (CCK). As a result, the gallbladder may secrete large amounts of bile into the upper arm, causing significant pain and discomfort.
Pathophysiology
The exact pathophysiology behind overactive gallbladder is not fully understood, but several mechanisms have been proposed. One theory suggests that changes in bile composition from metabolic disorders can lead to gallbladder hyperreactivity, resulting in increased muscle contractions. Additionally, increased levels of cholecystokinin or its receptors on smooth muscle cells can cause excessive gallbladder contractions. It is also believed that increased intraluminal pressures secondary to gallbladder contractility can lead to chronic inflammation and injury of the gallbladder wall.
Clinical Features
The most common clinical feature of an overactive gallbladder is right upper quadrant (RUQ) abdominal pain, often described as colicky, intense, or shooting in nature. This pain typically follows a meal and can last for several hours. Other common symptoms include indigestion, nausea, vomiting, bloating, flatulence, and a sense of fullness or bloating in the upper abdomen. In some cases, the symptoms may worsen after consumption of fat-rich foods. Physical examination may reveal tenderness to palpation in the RUQ, but routine blood tests and imaging studies typically do not show abnormal findings.
Differential Diagnosis
The differential diagnosis for an overactive gallbladder includes conditions such as biliary colic, gallstones, chronic biliary pancreatitis, and functional gallbladder disorders such as irritable bowel syndrome (IBS). The diagnosis is often based on a combination of clinical symptoms, historical features, and imaging findings.
Treatment
Treatment of an overactive gallbladder usually involves surgical intervention, specifically laparoscopic cholecystectomy. This procedure involves the removal of the entire gallbladder through a small incision. The goal of surgery is to alleviate symptoms and prevent further complications. After surgery, the majority of patients experience significant improvement in their symptoms within the first year of the procedure.
Complications
In the immediate postoperative period, complications such as infection, bleeding, or a bile leak may occur. However, these are typically managed conservatively, and the majority of patients recover without significant sequelae. Long-term complications are less common and can include recurrent biliary colic or pancreatitis.
Prevalence
Overactive gall膀胱的症状可能在儿童、青少年和成年人中发生。在美国，估计有1百万至5百万人口患有功能性腹胀。
