Gallbladder Disease

Written by Abdul Wadood Mohamed and Matthew Solan | Published on July 25, 2012
Medically Reviewed by George Krucik, MD

Overview

Gallbladder disease is a term for several types of conditions that can affect your gallbladder, a small pear shaped sac located under the liver. Your gallbladder’s main function is to store the bile produced in your liver and pass it along to the small intestine.

The majority of gallbladder diseases are caused by inflammation due to irritation to the gallbladder wall (cholecystitis). This occurs when gallstones obstruct the ducts leading to the small intestine and may eventually lead to necrosis or gangrene. Other diseases of the gallbladder include biliary enteric fistulas, sclerosing cholangitis, gallbladder polyps, and gallbladder cancer.

What are the Types of Gallbladder Disease?

Gallstones

Gallstones are the most pressing of all gallbladder diseases. They develop when substances in the bile (such as cholesterol, bile salts, and calcium) form hard particles that block the passageway to the gallbladder.

In addition, stones tend to form when the gallbladder doesn’t empty completely or often enough. They vary in size from as small as a grain of sand to as large as a golf ball.

Numerous factors contribute to your risk of gallstones. These include:

  • being overweight or obese
  • eating a high-fat or high-cholesterol diet
  • having diabetes
  • being age 60 or older
  • taking medications that contain estrogen
  • having a family history of gallstones
  • being a women

Cholecystitis

Cholecystitis is the most common type of gallbladder disease. It presents itself as either an acute or chronic inflammation.

Acute Cholecystitis

Acute cholecystitis is generally caused by gallstones, but may also be the result of tumors or various other illnesses. It may present with pain in the upper right side or upper middle part of the abdomen. The pain can come right after a meal and range from sharp pangs to dull aches that may often radiate to the right shoulder. Fever nausea, vomiting, jaundice, and different colored stools are also a result of acute cholecystitis.

Chronic Cholecystitis

After several attacks of acute cholecystitis, the gallbladder will shrink and lose its function of storing and releasing bile. Abdominal pain, nausea, and vomiting may follow.

Choledocholithiasis

Gallstones may become lodged in the neck of the gallbladder or in the bile ducts. When the gallbladder is plugged in this way, bile cannot exit. This may lead to the gallbladder becoming inflamed or distended. The plugged bile ducts will further prevent bile from traveling from the liver to the intestines. Choledocholithiasis produces extreme pain in the middle upper abdomen, fever, chills, nausea, and vomiting.

Acalculous Gallbladder Disease

Acalculous gallbladder disease (biliary dyskinesia) occurs without the presence of gallstones. It can be chronic or acute and may result from the gallbladder muscles or valve not working properly. Symptoms include abdominal pain on the right side of the body, radiating to the shoulder. Eating high fat foods often triggers this. Related symptoms may include nausea, vomiting, bloating, and loose stools.

Sclerosing Cholangitis

Sclerosing cholangitis is the inflammation, scarring, and damage to the bile ducts. It’s unknown what causes the disease. Symptoms may include an enlarged liver or spleen along with a decrease in appetite and weight loss.

Gallbladder Cancer

Cancer of the gallbladder is a relatively rare disease. If not treated, however, it can spread from the inner walls of the gallbladder, to the outer layers, and then to the other organs and ducts. Symptoms may be similar to those of acute cholecystitis.

Gallbladder Polyps

Gallbladder polyps are lesions or growths that occur on the gallbladder. They are usually harmless and the symptoms are often non-existent.

Gangrene of the Gallbladder

Gangrene develops when the gallbladder stops functioning because of inadequate blood flow. This may occur due to infections, injury, diabetes, surgery, or diseases related to blood circulation. Symptoms may include pain in the gallbladder region, fever, nausea, gas, disorientation, and low blood pressure.

Abscess of the Gallbladder

Abscess of the gallbladder results when an area of the body becomes inflamed with pus. Pus is the accumulation of white blood cells, dead tissue, and bacteria. It may present with upper right-sided pain in the abdomen.

How Is Gallbladder Disease Diagnosed?

To diagnose gallbladder disease, a comprehensive abdominal exam should be completed. This will include checking for pain in the abdomen, and one or more of the following tests and procedures may be used.

Detailed Patient History

A list of symptoms being experienced and any personal or family history of gallbladder disease are important. A general health assessment may also be performed to determine if any other signs of a long-term gallbladder disease are present.

Physical Exam

A doctor may attempt to elicit Murphy’s sign during an abdominal examination. This maneuver permits the gallbladder to be palpated (felt) and may suggest gallbladder disease.

Chest and Abdomen X-Ray

Symptomatic cholecystitis will show stones on 20 percent of abdominal X-rays if they contain calcium. An X-ray of the chest may show pleurisy or pneumonia. A normal X-ray should not deter from further investigation.

Ultrasonography

This is the main method of diagnosis and usually reveals the presence of gallstones, thickened walls, or any other problems within the gallbladder. Ultrasonography produces pictures with an instrument with sound waves.

Other Investigations

Blood tests are done to check for increased white blood cells and liver function.

How is Gallbladder Disease Treated?

Medical

For gallbladder inflammation where stones are not present, the first episode is often treated with antibiotics. If the patient returns with multiple episodes, surgery is recommended

Surgery

Sometimes surgery to remove the gallbladder is your best option. It can be done either by opening the abdomen, or laproscopically, which involves making three holes and inserting a camera. The type of surgery allows for easier and faster recovery with virtually no scar. If there are no urgent complications, most surgeons prefer this method.

Potential Long-Term Complications of Gallbladder Disease

The gallbladder may at some point form an abnormal passageway (fistula) to help process the liver’s bile. This is the most severe problem associated with gallbladder disease. Complications include obstruction of the intestine, inflammation, perforation (a hole in the gallbladder), bacterial contamination, and malignant transformation.

Can Gallbladder Disease be Prevented?

Diet may play a role in gallstones. According to the Medical Center at the University of Maryland, studies have found a lower risk of gallstones in people who consume foods with monosaturated fats or omega 3 fatty acids (found in fish oil). Fruits and vegetables, nuts, alcohol, and coffee appear to be associated with a lower risk of gallstones. Sugar consumption, however, is associated with a higher risk of gallbladder disease.

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