Disease: Gallbladder

What Is the Gallbladder?

You know you have a gallbladder, but do you know where it is or what it does?

Your gallbladder is one of the organs that you won't think too much about — unless something goes wrong.

Most people aren’t even certain where their gallbladder is located.

But when your gallbladder starts to hurt, you'll know right away where it is.

Where Is the Gallbladder?

"The gallbladder is located in the right upper quadrant of the abdomen right below the liver," says Tomasz Rogula, MD, PhD, a staff surgeon at the Bariatric and Metabolic Institute at the Cleveland Clinic in Ohio.

"If there are any problems, typically the patient complains of pain in this location — right below the ribs," adds Dr. Rogula. "Some patients also experience nausea."

The gallbladder is attached to the liver, is about four inches in size, and is oblong or pear-shaped.

What Does the Gallbladder Do?

The gallbladder's main function is to store bile, which helps the body break down and digest fats that you eat.

"The gallbladder is part of the biliary system, which serves as the storage reservoir for the bile," says Rogula.

"It does not produce the bile, but it stores the bile that is currently not being used by the body."

The liver produces bile, which flows through the bile ducts and into the gallbladder, says Rogula.

After a meal, bile is released by the gallbladder when the small intestine secretes a hormone called cholecystokinin.

Then the bile flows into the small intestine and helps to break down fats — for example, that big cheeseburger you just ate.

Life Without a Gallbladder

To treat certain gallbladder problems, sometimes the gallbladder must be surgically removed.

But not to worry — the gallbladder is one organ your body can do without.

People who undergo surgical removal of the gallbladder rarely have any problems with biliary system function after surgery, says Rogula.

The body can cope with losing its extra storage space for bile by filling the bile ducts — which transport bile from the liver to the small intestine — and using them to store the excess bile.

Sometimes, as a result of this surgery, Rogula notes that the bile ducts may become slightly distended, but this generally isn't a big concern.

Gallbladder Disorders

By far the most common gallbladder problem is gallstones — tiny stones that form from hardened bile and cholesterol.

Gallstones can block the release of bile from the gallbladder and cause:

  • Severe pain, particularly after eating fatty or greasy foods
  • Jaundice (yellowing of the skin and eyes)
  • Inflammation and irritation of the gallbladder walls

Other gallbladder problems may also occur, but these are extremely rare:

  • Gallbladder cancer
  • Perforation (tearing or rupture) of the gallbladder
  • Gangrene, if adequate blood flow to the gallbladder is blocked
  • Pancreatitis, caused by gallstones migrating out of the gallbladder and then blocking the pancreatic ducts
  • Bowel obstruction, caused by a gallstone passing into the intestine and then blocking the intestines

Gallbladder problems like gallstones may never cause any pain at all, but that doesn't mean that they will resolve themselves.

If you experience pain in your upper right abdomen — particularly after eating very fatty, heavy, or greasy foods — think about your gallbladder first.

See your doctor to get the problem checked out, and take care of your gallbladder problems.

What Are Gallstones?

Gallstones can cause severe abdominal pain — or, you may have no symptoms at all.

Having gallstones, also called cholelithiasis, is a very common problem, but it's most common among women, people older than age 40, and Native Americans.

The gallbladder is a sac that stores a substance called bile, which is produced by the liver.

After meals, the gallbladder contracts and releases bile into the intestines to aid in digestion.

Gallstones occur when one of the substances that make up the bile (usually a waste product called bilirubin, or cholesterol) becomes too concentrated and forms a hard stone.

Often gallstones just sit in the gallbladder and don’t cause problems. But sometimes they block the exit from the gallbladder, called the cystic duct.

When this occurs, the gallbladder goes into spasms and becomes inflamed, a condition called cholecystitis.

An episode of cholecystitis may resolve on its own, or it may progress to a more serious condition involving bacterial infection of the inflamed gallbladder.

Causes of Gallstones

Many different factors can cause gallstones. Some possible causes include:

  • Excess bilirubin in the bile
  • Excess cholesterol in the bile
  • A non-stone-related blockage in the gallbladder that prevents proper emptying
  • Low bile concentration of a substance called bile salts

Risk Factors

The risk factors for gallstones include:

  • A family history of gallstones
  • Taking medications to lower cholesterol levels
  • Having diabetes
  • A rapid, large loss of weight
  • Taking birth control pills or hormone replacement therapy
  • Being pregnant
  • Being overweight
  • Eating a diet rich in fat and cholesterol and without enough fiber

Gallstone Symptoms

It's not uncommon for gallstones to cause no symptoms at all, and to be diagnosed during screening and testing for some other health problem.

But, in many people, gallstones can cause the symptoms of cholecystitis, including:

  • Abdominal pain in the right upper part of the abdomen
  • Back pain, particularly located between your shoulder blades
  • Pain beneath the right shoulder blade
  • Pain in those areas which comes on quickly, worsens, and persists for at least 30 minutes, and may even last for a few hours
  • Fever with chills
  • Vomiting and nausea
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Stools the color of clay
  • Pain that strikes after eating a fatty meal
  • Indigestion, bloating, and gas

If you have any of these symptoms, it’s possible that gallstones may be to blame, so it's important to head to your doctor for an exam and to get started on treatment.

Gallstones may also rarely be an indication of gallbladder cancer, so it's best to get the problem correctly diagnosed right away.

Diagnosis

If gallstones are suspected, your doctor may order an imaging test.

This might include an ultrasound, which uses sound waves to visualize the area.

Another frequently used test is an oral cholecystogram (OCG), which uses X-rays to show the gallbladder after the patient swallows pills containing a dye.

Another procedure, called a HIDA scan, involves injection of a small amount of a harmless radioactive substance.

Sometimes gallstones show up as an incidental finding on other tests, such as a CT scan.

Gallstone Treatment

There are a number of options for treating gallstones, depending on symptoms and how severe they are.

Possible treatment methods for gallstones include:

Surgery: The gallbladder is often surgically removed, but generally only if you experience severe symptoms.

Significant advancements have been made with cholecystectomy, or gallbladder removal surgery. It's now a less invasive procedure using laparoscopic technology.

Tiny incisions are made, recovery is quick, and you may not even have to spend the night in the hospital following surgery.

Dietary changes: Your doctor may recommend that you switch to a healthier, low-fat diet to help relieve your gallstone symptoms.

Medication: A few types of medications, including bile salts, work to slowly break down small gallstones to reduce pain and symptoms. Not everyone is a good candidate for this type of gallstone therapy.

Lithotripsy: Forceful sound waves are aimed directly at the gallstones to break them into tiny fragments, usually followed by medications to dissolve these pieces.

Painkillers: These may be recommended to control pain during an acute attack of cholecystitis.

As for new treatment techniques, one experimental gallstone treatment involves injecting the gallbladder with a medication that dissolves the gallstones in a matter of days.

But there are side effects. This therapy is being tested in patients whose gallstones are small.

Symptoms of Gallbladder Problems

The gallbladder isn't an organ that gets a lot of attention — unless it's causing you pain.

The gallbladder is a little sac that stores bile from the liver, and it's found just beneath your liver.

The gallbladder releases bile, via the cystic duct, into the small intestine to help break down the foods you eat — particularly fatty foods.

Typically the gallbladder doesn't cause too many problems or much concern, but if something slows or blocks the flow of bile from the gallbladder, a number of problems can result.

What Can Go Wrong

Some common gallbladder problems include:

Gallstones (cholelithiasis): This is the name of the condition when small stones, or sometimes larger ones, develop inside the gallbladder.

Gallstones may cause pain known as biliary colic (see below), but about 90 percent of people with gallstones will have no symptoms.

Most symptomatic gallstones have been present for a number of years.

For unknown reasons, if you have gallstones for more than 10 years, they are less likely to cause symptoms.

Biliary colic: This is the term often used for the severe episodes of pain that can be caused by gallstone blockage of the cystic duct.

The gallbladder contracts vigorously against the blockage, causing spasmodic (or sometimes constant) severe pain.

Biliary colic episodes usually last only an hour or two. They may recur infrequently, often years apart.

Inflamed gallbladder (cholecystitis): Inflammation of the gallbladder can be caused by gallstones, excessive alcohol use, infections, or even tumors that cause bile buildup.

But the most common cause of cholecystitis is gallstones.

The body can react to the gallstone irritation by causing the gallbladder walls to become swollen and painful.

The episodes of inflammation can last for several hours, or even a few days. Fever is not unusual.

About 20 percent of the time, the sluggish, inflamed gallbladder is invaded by intestinal bacteria, and becomes infected.

Occasionally, the gallbladder actually ruptures, which is a surgical emergency.

Suspected episodes of cholecystitis always require medical attention, particularly if fever is present.

Dysfunctional gallbladder or chronic gallbladder disease: Here, the gallbladder may become rigid and scarred from gallstones and repeated episodes of inflammation.

Symptoms are more constant, but tend to be vague, including abdominal fullness, indigestion, and increased gas.

Chronic diarrhea is a common symptom, usually occurring after meals, and up to 10 times per day.

Common Gallbladder Symptoms 

Specific symptoms may vary based on what type of gallbladder condition you have, although many symptoms are common among the different types of gallbladder problems.

But most gallbladder symptoms start with pain in the upper abdominal area, either in the upper right or middle.

Below are common symptoms of gallbladder conditions:

  • Severe abdominal pain
  • Pain that may extend beneath the right shoulder blade or to the back
  • Pain that worsens after eating a meal, particularly fatty or greasy foods
  • Pain that feels dull, sharp, or crampy
  • Pain that increases when you breathe in deeply
  • Chest pain
  • Heartburn, indigestion, and excessive gas
  • A feeling of fullness in the abdomen
  • Vomiting, nausea, fever
  • Shaking with chills
  • Tenderness in the abdomen, particularly the right upper quadrant
  • Jaundice (yellowing of the skin and eyes)
  • Stools of an unusual color (often lighter, like clay)

Some gallbladder problems, like simple gallstones that are not blocking the cystic duct, often cause no symptoms at all.

They're most often discovered during an X-ray or CT scan that's performed to diagnose a different condition, or even during an abdominal surgery.

If you spot any symptoms of gallbladder trouble, head to your doctor for a diagnosis and prompt treatment to get your digestive tract running smoothly again.

What Is Cholecystitis?

Cholecystitis is a big word for the simple — but potentially painful — problem of gallbladder inflammation.

The gallbladder holds bile from the liver, and releases it into the small intestine.

When a gallstone forms, it can wedge itself in the duct that releases bile — causing bile buildup and a painful condition called cholecystitis.

Cholecystitis, or gallbladder inflammation, occurs when bile can't circulate out of the liver as it normally does.

When bile builds up, it causes the gallbladder to thicken, harden, swell, and become irritated.

The abdomen becomes painful, and infection can occur if bile can't flow properly.

Symptoms of Cholecystitis

The most common symptoms of cholecystitis are:

  • Fever
  • Severe and sudden pain in the upper right portion of the abdomen
  • Pain that persists for more than six hours
  • Pain after eating a meal
  • Nausea
  • Vomiting
  • Bloating
  • Soreness in the right part of the abdomen

Although it's easy to mistake the symptoms of cholecystitis for some other simple problem, it's important to get a proper medical diagnosis.

Untreated cholecystitis can lead to complications, so don't brush off these symptoms as just a little indigestion or a stomach bug.

Cholecystitis can be chronic — persistent and long-lasting swelling and damage to the gallbladder — or acute, a sudden "attack" that causes swelling and irritation of the gallbladder.

Persistent acute attacks of cholecystitis can lead to chronic cholecystitis.

Causes of Cholecystitis

Some of the most common causes of cholecystitis include:

  • Gallstones becoming lodged in the duct of the gallbladder, preventing bile from emptying
  • Complications from some other health condition like diabetes or HIV
  • Persistent cholecystitis attacks and consistent swelling
  • Gallbladder sludge — a thick substance that pollutes the gallbladder and can't be absorbed. Pregnant women and people who have lost a lot of weight in a short period of time can experience this.
  • A tumor in the liver or pancreas
  • Reduced blood flow to the gallbladder
  • Bacterial infection that strikes the bile duct system, which empties bile from the gallbladder

Treatment of Cholecystitis

Cholecystitis can be easily diagnosed with an exam, medical history, ultrasounds, X-rays, and some imaging tests to detect gallbladder inflammation.

Once diagnosed, cholecystitis can be treated with:

  • Cholecystectomy, the surgical removal of the gallbladder — the most common treatment
  • Switching to a low-fat diet
  • Medications to manage pain
  • Medications to dissolve the gallstones
  • Medications to keep gallstones from forming

People with mild cholecystitis may just have to adjust their diet, take antibiotics, and drink plenty of fluids to allow the inflammation to subside.

More serious cases of cholecystitis require more involved methods.

Treatment generally requires a stay in the hospital, as well as antibiotics to manage inflammation and infection in the gallbladder.

Treatment is necessary to prevent complications of cholecystitis, such as jaundice, pancreatitis (inflammation of the pancreas), gallbladder cancer, or gallbladder inflammation that just gets worse.

Which treatment is right for you will depend on your symptoms, your age, how well you can tolerate the treatment, and your general health.

If you have symptoms, you should see a doctor about a diagnosis and figure out the right treatment plan to tackle cholecystitis.

Gallbladder Cancer

Gallbladder cancer doesn't strike often, but when it does, it's often diagnosed at a late stage.

Gallbladder cancer is rare, with fewer than 5,000 new diagnoses each year in the United States.

Of those, fewer than 1,700 people will die from the disease.

Gallbladder cancer is the most common type of cancer found in the bile tract, and is more common in women and people older than age 60.

Risk Factors

Though gallbladder cancer doesn't affect a huge number of Americans each year, it's still a concern.

Most of the time, it's diagnosed at a late stage — making treatment difficult.

Only about one in three cases of gallbladder cancer is diagnosed early, before the cancer spreads beyond the gallbladder.

Some of the most common risk factors for gallbladder cancer are:

  • Gallstones
  • Gallbladder polyps
  • Being overweight or obese
  • Being of Native American descent
  • Being older than age 65
  • Being female
  • A condition called porcelain gallbladder, in which the gallbladder wall hardens with deposits of calcium
  • Having had typhoid (very rare in the United States)
  • Choledochal cysts — sacs of bile that form on the common bile duct
  • An abnormality of the bile ducts
  • A family history of gallbladder cancer

Gallstones are the biggest indicator of a person's likelihood of developing gallbladder cancer, but the relationship can be tricky to understand.

About three out of four people who have gallbladder cancer also have gallstones at diagnosis.

But gallstones happen very frequently — and gallbladder cancer is very rare.

So although people with gallbladder cancer are more likely to also have gallstones, only a very small percentage of people with gallstones will develop gallbladder cancer.

Gallbladder Adenocarcinomas

There are a few types of gallbladder cancer, but the most common are adenocarcinomas — 9 out of 10 cases of gallbladder cancer are adenocarcinomas.

Adenocarcinoma gallbladder cancer begins in gland-like cells that are found in the digestive tract’s lining, including the gallbladder.

There's a subtype of gallbladder adenocarcinoma called papillary adenocarcinoma, also called papillary cancer.

Papillary adenocarcinomas make up about 6 percent of all types of gallbladder cancer.

This type of gallbladder cancer can be distinguished under a microscope, as the cancer cells growth looks like fingers.

The prognosis for papillary adenocarcinoma is often better than other gallbladder cancer types, as it is less likely to affect lymph nodes and the liver.

Gallbladder Carcinomas

Other types of gallbladder cancers are even rarer than the adenocarcinomas:

  • Squamous cell carcinomas: These cancers initially form in the squamous cells — flat, skin-like cells that line parts of the digestive tract.
  • Adenosquamous carcinomas: This type of gallbladder cancer is made up of two different kinds of cells, squamous cells and the glandular cells found in adenocarcinomas.
  • Small-cell carcinomas: Also called oat cell carcinoma, this type of gallbladder cancer is a very dangerous cancer whose cells are round or oat-shaped.
  • Neuroendocrine gallbladder tumors: These types of gallbladder cancer tumors grow from tissues that produce hormones. The most common form is the carcinoid tumor.
  • Sarcoma gallbladder cancer: Sarcomas are a type of cancer arising from the connective tissues in the body. Connective tissues support and protect the body, and include nerves, muscles, and blood vessels. In the gallbladder, sarcomas form in the muscular tissue of the gallbladder.
  • Gallbladder lymphoma: This is an extremely rare type of gallbladder cancer. Treatment is often different than for other types of gallbladder cancer, and often may be treated with chemotherapy and radiation therapy instead of surgery.

Though all types of gallbladder cancer are rare, it's important to understand the risk factors for gallbladder cancer and what types may strike.

The earlier gallbladder cancer can be diagnosed, the better the prognosis may be.

Gallbladder Surgery

Doctors use several different surgical procedures to help treat your gallbladder disease.

If you're having gallbladder symptoms caused by gallstones or other conditions, your doctor may recommend a surgical procedure as part of your treatment.

But there's no such thing as a one-size-fits-all gallbladder surgery.

Here are some gallbladder surgery options that your doctor might discuss with you.

Cholecystectomy

This is the medical term for a surgery to completely remove the gallbladder.

Remarkably, your body doesn't need a gallbladder to digest food.

In the United States, cholecystectomy is a very common operation.

If possible, most surgeons will opt for the laparoscopic form of this gallbladder surgery, in which the gallbladder is removed through a small incision in the abdomen.

"It's a 'Band-Aid' surgery, and the recovery is much easier," says Harold Berenzweig, MD, a gastroenterologist at Texas Health Harris Methodist in Fort Worth, Texas.

Some patients can go home the same day, Berenzweig adds. Others may spend one night in the hospital.

However, if the surgeon cannot reach your gallbladder laparoscopically, or other complications occur, your surgeon may opt for an open cholecystectomy, which involves making an incision on the upper right side of your abdomen to remove the gallbladder.

This type of gallbladder surgery is necessary in about 5 percent of cases.

In laparoscopic surgery, four tiny incisions are made in the abdominal wall, just big enough for the surgeon's laparoscope and small instruments (the gallbladder is also pulled out through one of these incisions).

In an open cholecystectomy, a large (six inches across) incision is made in the right upper quadrant of the abdomen.

This larger incision cuts through muscles, which results in more pain and discomfort.

Healing time is usually longer for the open cholecystectomy because of the larger incision made.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

This procedure, generally called ERCP, is used when one or more gallstones have migrated out of the gallbladder and into the common bile duct, which carries bile to the small intestine to aid in digestion.

During ERCP, an endoscope — a long tube with a camera in it — is guided down your throat into the stomach and then into the common bile duct.

If gallstones are present, an instrument can be inserted into the endoscope to remove them.

Patients are generally awake during an ERCP, but are given a sedative to help them relax.

ERCP is usually performed in conjunction with gallbladder removal.

"You can't take out the stones and leave the gallbladder, because you're going to form more stones," Berenzweig says.

Gallbladder Draining (Cholecystostomy)

During this minimally invasive procedure, also known as a cholecystostomy, the doctor will insert a needle through the abdomen to drain the gallbladder of bile and decompress it.

This is usually performed on patients with severe gallbladder problems as well as other medical conditions who might not be able to withstand surgery to remove the gallbladder.

With cholecystostomy, "you're still left with a gallbladder full of gallstones," Berenzweig says. "It's not done very commonly at all anymore."

After a cholecystostomy, some patients improve and are later able to have their gallbladders removed.

A Non-Surgical Option

The gallbladder can also be treated with non-surgical techniques like lithotripsy, which uses high-energy sound waves to break gallstones into tiny pieces so they can drain out of the gallbladder.

Although it is most commonly used to treat kidney stones, it can also be used on gallstones.

However, it's unlikely that your surgeon will recommend lithotripsy for gallstones.

"I don't know of anyone who's had that done lately," Berenzweig says.

Gallbladder and Diet

After gallbladder surgery, digestion can be tricky for a while - here's what to avoid.

When you have a problem with your gallbladder, like gallstones, your doctor may recommend that you have gallbladder surgery to remove your gallbladder.

Your gallbladder is an organ that you can live without, but some people need to avoid certain foods after gallbladder removal.

The Gallbladder and Digestion

The gallbladder is a small organ that sits under your liver.

It stores, concentrates, and helps secrete bile, a liquid made by your liver that helps digest fatty foods.

If you need to have surgery to remove your gallbladder, your liver still makes enough bile for normal digestion.

Even so, it is not unusual for people to have some difficulty digesting certain foods in the days and weeks following gallbladder surgery.

Dietary Adjustments

It's important to carefully follow your doctor's instructions about your diet after gallbladder surgery.

If you're hospitalized, your medical team will help you transition from a liquid to a solid diet almost immediately after your gallbladder surgery.

If you're recovering at home, you'll need to introduce foods slowly, and consume mainly clear liquids, like broth and gelatin, at first.

If you feel ready and are not nauseated, you can slowly begin introducing solid foods back into your diet as you start feeling better.

But you may need to avoid certain types of foods for a while.

More than half of people who have recently had gallbladder surgery report problems with digesting fats following their surgery.

This is because your gallbladder is no longer there to control the release of bile into your intestines after eating a meal.

Instead, a small amount of bile is now directly "leaked" from your liver into your small intestine at a slow, constant rate.

It can take a few weeks for your body to get used to this change, and you may experience bloating, diarrhea, and gas after eating fatty foods during this time.

But most people can return to a normal diet within a month after having gallbladder surgery.

Foods to Avoid

While your body adjusts, it's a good idea to avoid high-fat foods for a few weeks after having gallbladder surgery.

High-fat foods include:

  • Foods that are fried, like French fries and potato chips
  • High-fat meats, such as bacon, bologna, sausage, ground beef, and ribs
  • High-fat dairy products, such as cheese, ice cream, cream, whole milk, and sour cream
  • Pizza
  • Foods made with lard or butter
  • Creamy soups or sauces
  • Meat gravies
  • Chocolate
  • Oils, such as palm and coconut oil
  • Skin of chicken or turkey

High-fiber and gas-producing foods can also cause some people discomfort after gallbladder surgery, so you may want to introduce them slowly back into your diet.

These include:

  • Cereals
  • Whole-grain breads
  • Nuts
  • Seeds
  • Legumes
  • Brussels sprouts
  • Broccoli
  • Cauliflower
  • Cabbage

Spicy foods may also cause some gastrointestinal symptoms for a short time after gallbladder removal.

If you need help devising a diet plan after your surgery, ask your doctor to refer you to a registered dietitian.

Will a Gallbladder Cleanse Help?

Sometimes news of an alternative remedy will spread rapidly through Web sites and other media.

But just because you are reading about it everywhere does not mean that a remedy is effective or even safe.

One such alternative gallbladder treatment is the so-called gallbladder cleanse.

There are many different recipes for this so-called “cleanse,” but most involve drinking large amounts of citrus juices, Epsom salts, and olive oil.

The advertised promises sound enticing, especially if you’re facing the cost and hassle of a cholecystectomy, a surgery to remove your gallbladder.

But there are no gallbladder flushes or cleanses that have been proven to break up or eliminate gallstones, says Sanjay Jagannath, MD, a gastroenterologist at Mercy Medical Center in Baltimore.

“There’s not any good evidence out there to suggest there’s anything out there to reliably do that,” Dr. Jagannath says.

One popular homemade gallbladder cleanse recipe prescribes a combination of apple juice, lemon juice, and olive oil to eliminate gallstones.

Others suggest using a Chinese herb called gold coin grass.

Jagannath says people who ingest these remedies often have subsequent bowel movements that include small round objects thought to be gallstones.

However, he adds, the objects are actually the result of the olive oil mixing with bile, the fluid in the gallbladder that digests fat.

“Bile mixes with olive oil to form a yellowish-colored soap,” Jagannath says. “There are no real stones actually pushed out by the gallbladder in most cases.”

Jagannath adds that these objects usually float in the toilet, while real gallstones are hard — like pebbles — and sink to the bottom.

“The problem with all herbal treatments is there’s no regulation by the FDA,” Jagannath warns.

“If you go to [a natural-remedies store] and get a product, there’s no one breaking down the percentages of the products and stating the percentages of active ingredients.”

It’s always advisable to check with your doctor before beginning any kind of over-the-counter treatment for gallbladder problems, Jagannath adds.

When to Call Your Doctor

Although it's common to have some food-related symptoms after surgery, it is important to contact your surgeon if you experience the following symptoms, since they may be symptoms of a serious complication:

  • Persistent, worsening, or severe abdominal pain
  • Severe nausea or vomiting
  • Yellowing of your skin, called jaundice
  • No bowel movement for more than three days after surgery
  • Inability to pass gas for more than three days after surgery
  • Frequent diarrhea that lasts for more than three days after surgery

Source: http://www.everydayhealth.com

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