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Gallbladder Disease

Overview of gallbladder disease

The term gallbladder disease is used for several types of conditions that can affect your gallbladder.

The gallbladder is a small pear-shaped sac located underneath your liver. Your gallbladder’s main function is to store the bile produced by your liver and pass it along through a duct that empties into the small intestine. Bile helps you digest fats in your small intestine.

Inflammation causes the majority of gallbladder diseases due to irritation of the gallbladder walls, which is known as cholecystitis. This inflammation is often due to gallstones blocking the ducts leading to the small intestine and causing bile to build up. It may eventually lead to necrosis (tissue destruction) or gangrene.

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Types

What are the types of gallbladder disease?

There are many different types of gallbladder disease.

Gallstones

Gallstones develop when substances in the bile (such as cholesterol, bile salts, and calcium) or substances from the blood (like bilirubin) form hard particles that block the passageways to the gallbladder and bile ducts.

Gallstones also tend to form when the gallbladder doesn’t empty completely or often enough. They can be as small as a grain of sand or as large as a golf ball.

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

  • being overweight or obese
  • having diabetes
  • being age 60 or older
  • taking medications that contain estrogen
  • having a family history of gallstones
  • being female
  • having Crohn’s disease and other conditions that affect how nutrients are absorbed
  • having cirrhosis or other liver diseases

Cholecystitis

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

Acute cholecystitis

Acute cholecystitis is generally caused by gallstones. But it 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 tends to occur right after a meal and ranges from sharp pangs to dull aches that can radiate to your right shoulder. Acute cholecystitis can also cause:

Chronic cholecystitis

After several attacks of acute cholecystitis, the gallbladder can shrink and lose its ability to store and release bile. Abdominal pain, nausea, and vomiting may occur. Surgery is often the needed treatment for chronic cholecystitis.

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 can’t 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 can cause:

Acalculous gallbladder disease

Acalculous gallbladder disease is inflammation of the gallbladder that occurs without the presence of gallstones. Having a significant chronic illness or serious medical condition has been shown to trigger an episode.

Symptoms are similar to acute cholecystitis with gallstones. Some risk factors for the condition include:

  • severe physical trauma
  • heart surgery
  • abdominal surgery
  • severe burns
  • autoimmune conditions like lupus
  • blood stream infections
  • receiving nutrition intravenously (IV)
  • significant bacterial or viral illnesses

Biliary dyskinesia

Biliary dyskinesia occurs when the gallbladder has a lower-than-normal function. This condition may be related to ongoing gallbladder inflammation.

Symptoms can include upper abdominal pain after eating, nausea, bloating, and indigestion. Eating a fatty meal may trigger symptoms. There are usually no gallstones in the gallbladder with biliary dyskinesia.

Your doctor may need to use a test called a HIDA scan to help diagnosis this condition. This test measures gallbladder function. If the gallbladder can only release 35 to 40 percent of its contents or less, then biliary dyskinesia is usually diagnosed.

Sclerosing cholangitis

Ongoing inflammation and damage to the bile duct system can lead to scarring. This condition is referred to as sclerosing cholangitis. However, it’s unknown what exactly causes this disease.

Nearly half the people with this condition don’t have symptoms. If symptoms do occur, they can include:

  • fever
  • jaundice
  • itching
  • upper abdominal discomfort.

Approximately 60 to 80 percent of people with this condition also have ulcerative colitis. Having this condition does increase the risk of liver cancer as well. Currently, the only known cure is a liver transplant.

Medications that suppress the immune system and those that help break down thickened bile can help manage symptoms.

Gallbladder cancer

Cancer of the gallbladder is a relatively rare disease. There are different types of gallbladder cancers. They can be difficult to treat because they’re not often diagnosed until late in the disease’s progression. Gallstones are a common risk factor for gallbladder cancer.

Gallbladder cancer can spread from the inner walls of the gallbladder to the outer layers and then on to the liver, lymph nodes, and other organs. The symptoms of gallbladder cancer may be similar to those of acute cholecystitis, but there may also be no symptoms at all.

Gallbladder polyps

Gallbladder polyps are lesions or growths that occur within the gallbladder. They’re usually benign and have no symptoms. However, it’s often recommended to have the gallbladder removed for polyps larger than 1 centimeter. They have a greater chance of being cancerous.

Gangrene of the gallbladder

Gangrene can occur when the gallbladder develops inadequate blood flow. This is one of the most serious complications of acute cholecystitis. Factors that increase the risk of this complication include:

  • being male and over 45 years old
  • having diabetes

The symptoms of gallbladder gangrene can include:

Abscess of the gallbladder

Abscess of the gallbladder results when the gallbladder becomes inflamed with pus. Pus is the accumulation of white blood cells, dead tissue, and bacteria. Symptoms may include upper right-sided pain in the abdomen along with fever and shaking chills.

This condition can occur during acute cholecystitis when a gallstone blocks the gallbladder completely, allowing the gallbladder to fill with pus. It’s more common in people with diabetes and heart disease.

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Diagnosis

How is gallbladder disease diagnosed?

To diagnose gallbladder disease, your doctor will ask you about your medical history and perform an abdominal exam. This will include checking for pain in the abdomen. One or more of the following tests and procedures may be used:

Detailed medical history

A list of symptoms you’re experiencing and any personal or family history of gallbladder disease are important. A general health assessment may also be performed to determine if there are any signs of a long-term gallbladder disease.

Physical exam

Your doctor may perform a special maneuver during the abdominal exam to look for what’s referred to as “Murphy’s sign.”

During this maneuver, your doctor will put their hand on your abdomen over the area of the gallbladder. They’ll then ask you to take a breath while examining and feeling the area. If you feel significant pain, it suggests you may have gallbladder disease.

Chest and abdominal X-ray

Symptomatic cholecystitis will sometimes show stones on abdominal X-rays if the stones contain calcium. An X-ray of the chest may show pleurisy or pneumonia.

However, X-rays aren’t the best test for identifying gallbladder disease. They’re often used to rule out other potential causes of pain that’s not related to gallstones, the gallbladder, or the liver.

Ultrasound

An ultrasound uses sound waves to produce images inside your body. This test is one of the main methods your doctor uses to make a diagnosis of gallbladder disease. An ultrasound can evaluate the gallbladder for the presence of gallstones, thickened walls, polyps, or masses. It can also identify any issues within your liver.

HIDA scan

A HIDA scan looks at the duct system within the gallbladder and liver. It’s often used when a person has gallbladder symptoms but the ultrasound didn’t show a reason for the symptoms. A HIDA scan can also be used for a more thorough evaluation of the bile duct system.

This test can evaluate the function of the gallbladder using a harmless radioactive substance. The substance is injected into a vein and then watched as it moves through the gallbladder. Another chemical may also be injected that causes the gallbladder to release bile.

A HIDA scan shows how the gallbladder moves bile through the bile duct system. It can also measure the rate of bile moving out of the gallbladder. This is known as the ejection fraction. A normal ejection fraction for the gallbladder is considered between 35 to 65 percent.

Other tests

Other imaging tests, such as a CT and MRI scan, can also be used. Blood tests are also done to check for increased white blood cell counts and abnormal liver function.

Endoscopic retrograde cholangiopancreatography (ERCP) is a more invasive but useful test. A flexible camera is inserted into the mouth and down past the stomach into the small intestine. Contrast dye is injected to show the bile duct system with a specialized X-ray.

ERCP is an especially useful test if a blockage due to gallstones is suspected. Any gallstone that is causing blockage can often be removed during this procedure.

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Treatment

How is gallbladder disease treated?

Lifestyle changes

Since certain health conditions increase the risk of gallstone formation, changes in lifestyle may help manage gallbladder disease in people without symptoms. Being overweight and having diabetes increases the likelihood of gallstones. Losing weight and getting good control over diabetes may help lower your risk.

However, rapid weight loss can also trigger gallstone formation. Talk to your doctor about safe ways to lose weight.

Increasing physical activity also appears to decrease gallstone formation along with lowering high triglycerides, a type of fat in the blood. It’s often recommended to quit smoking and limit alcohol intake as well.

Medical treatment

The first episode of gallbladder inflammation is often treated with pain medications. Because the pain is often severe, prescription medications are needed. Your doctor may prescribe medications with codeine or hydrocodone. IV prescription anti-inflammatories may be prescribed, or stronger pain medications like morphine.

Over-the-counter medications like ibuprofen (Advil) and naproxen (Aleve) may not be used as often due to the increased risk of nausea and vomiting. If you’re dehydrated, anti-inflammatory drugs may also cause severe kidney issues.

Most people have difficulty managing the pain and its accompanying symptoms at home. Talk with your doctor to discuss the best treatment for you.

Ongoing research is looking into the use of the medication ezetimibe and its role in decreasing the formation of cholesterol gallstones. This medication changes how the body absorbs cholesterol from the intestinal tract.

Surgery

Surgery will be recommended to remove your gallbladder if you’ve experienced multiple episodes of inflammation. Gallbladder surgery continues to be the most effective method for treating active gallbladder disease.

The surgery can be done either by opening your abdomen with an incision, or laparoscopically. This involves making several poke holes through the abdominal wall and inserting a camera. Laparoscopic surgery allows for faster recovery. This method is preferred for people who don’t have complications of significant gallbladder disease.

After gallbladder surgery by either method, it’s not uncommon for people to experience some diarrhea. According to the Mayo Clinic, up to 3 out of 10 people can have diarrhea after gallbladder surgery.

For most people, diarrhea will only last a few weeks. But in a few cases, it can last for years. If diarrhea is continuing after surgery for more than two weeks, talk to your doctor. Depending on other symptoms, you may require follow-up testing.

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Complications

Potential long-term complications of gallbladder disease

The gallbladder may form an abnormal passageway, or fistula, between the gallbladder and the intestine to help process the liver’s bile. This is most often a complication of chronic inflammation related to gallstones.

Other complications can include:

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Prevention

Can gallbladder disease be prevented?

Certain risk factors for gallbladder disease, such as sex and age, can’t be changed. However, your diet may play a role in developing gallstones. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), foods high in fiber and healthy fats may help prevent gallstones.

Refined grains (found in sugary cereals and white rice, bread, and pasta) and sugary sweets are associated with a higher risk of gallbladder disease. Whole grains like brown rice and whole wheat bread and fats from fish and olive oil are all recommended.

The earlier gallbladder problems are recognized and treated, the less likely significant complications will occur. It’s important to talk to your doctor if you’re experiencing any signs or symptoms of gallbladder disease. 

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