Most people don’t pay their gallbladder much attention until it starts causing problems. It may, however, be very painful when there is a problem, and require immediate action.
The gallbladder is a 4-inch-long, pear-shaped organ located in the upper right abdomen area under the liver. It stores bile, a liver-producing compound for digestion of fat, and helps the body absorb fat-soluble vitamins and nutrients.
The process happens painlessly in a balanced gallbladder. However, significant pain and discomfort may occur when blockage occurs in the gallbladder, or when it stops working correctly.
In this article , we look at the gallbladder function, some common problems with the gallbladder and their symptoms, treatment options, and the long-term perspective.
Common problems
Some common gallbladder problems include:
Gallstones, or cholelithiasis
Gallstones are solid cholesterol or pigment masses and can be of various sizes.
They occur when the high fat and bile levels induce the formation of crystals. Over time these crystals can combine and expand into stones.
Stones may be as low as a sand grain or as big as a golf ball and symptoms can or may not occur
Common bile duct stones, or choledocholithiasis
Short tubes bring bile from the gallbladder and place it in the common bile duct. It is moved from there into the small intestine. Gallstones can sometimes lodge or form within the common bile duct.
These stones most often start their life in the gallbladder and move to the common bile duct. This is a secondary common bile duct stone, or secondary stone.
It is a primary stone, or primary common bile duct stone, if the stone forms inside the duct itself. These are less common but are more likely than secondary stones to cause an infection.
Gallbladder cancer
Gallbladder cancer is extremely rare, affecting fewer than 4,000 Americans a year; however, it may spread to other areas of the body if it does happen.
Risk factors include gallstones, gallbladder porcelain (described below), gender female, obesity and older age.
Inflamed gallbladder, cholecystitis
Acute or sudden cholecystitis occurs when bile can’t leave the gallbladder. This is commonly the case when a gallstone obstructs the tube used by bile to travel into and out of the gallbladder.
Chronic cholecystitis occurs when acute attacks recur.
Bile builds up when the bile duct is blocked. The excess bile irritates the gallbladder which results in swelling and infection. The gallbladder gets weakened over time, so it can no longer fully function.
Perforated gallbladder
If gallstones are left untreated, they can lead to a perforated gallbladder-that is, a hole in the organ wall may develop. A condition of acute cholecystitis also occurs in perforation.
This breach in the wall of the gallbladder may allow infection to leak into other parts of the body which causes a serious, widespread infection.
Common bile duct infection
This can lead to an infection if the common bile duct is blocked. This can be treated if detected early; however, it can spread and develop into a serious , life-threatening infection if missed.
Dysfunctional gallbladder or chronic gallbladder disease
Repeated episodes of attacks by gallstones or cholecystitis can permanently damage the gallbladder. It can give rise to a stiff, scarred gallbladder.
Symptoms can be difficult to pinpoint in this case. They entail fullness of the belly, indigestion and increased gas and diarrhea.
Gallstone ileus
Gallstone is a rare ileus but it can be fatal. It occurs when a gallstone migrates to, and blocks, the intestine. Emergency surgery is also required to remove the blockage.
Gallbladder abscess
A patient with gallstones will also sometimes develop pus in the gallbladder; this is called empyema. The condition may be causing severe abdominal pain. If it isn’t handled it can be life-threatening.
Individuals with diabetes, a weakened immune system, and obesity have an increased risk of this condition emerging.
Porcelain (calcified) gallbladder
The porcelain gallbladder is a condition in which the gallbladder’s muscular walls produce a buildup of calcium over time. Which makes them stiff, limiting the function of the gallbladder, and increasing the risk of cancer of the gallbladder.
The word “porcelain” is used because it turns the organ bluish and brittle.
Gallbladder polyps
Polyps are a type of growth that is typically benign (noncancerous). Smaller polyps of the gallbladder frequently cause no complications, and rarely cause any symptoms. People may need to remove larger polyps.
Symptoms
Symptoms of gallbladder problems include:
- Pain in the mid- or upper-right section of the abdomen: Most of the time, gallbladder pain comes and goes. However, pain from gallbladder problems ranges from mild and irregular to very severe, frequent pain. Gallbladder pain often causes pain in the chest and back.
- Nausea or vomiting: Any gallbladder problem may cause nausea or vomiting. Long-term gallbladder diseases and disorders may lead to long-standing digestive problems that cause frequent nausea.
- Fever or shaking chill: This signals an infection in the body. Alongside other gallbladder symptoms, fever and chills may point to a gallbladder problem or infection.
- Changes in bowel movements: Gallbladder problems often cause changes in bowel habits. Frequent, unexplained diarrhea can signal a chronic gallbladder disease. Light-colored or chalky stools may point to a problem with the bile ducts.
- Changes in urine: Patients suffering from gallbladder issues may notice darker than normal urine. Dark urine may indicate a bile duct block.
- Jaundice Yellowing of the skin occurs when liver bile does not successfully reach the intestines. This normally happens due to a problem with the liver or due to a blockage in the bile ducts caused by gallstones.
When to see a doctor
It is advised that anyone with gallbladder symptoms seek medical attention. There is no need for immediate attention to mild, intermittent pain which goes away by itself. Patients with this form of pain should also make an appointment with their doctor for further review.
When the signs are more severe, which include the following, immediately a patient should be seen:
- upper-right quadrant pain that does not go away within 5 hours
- fever, nausea, or vomiting
- changes in bowel movement and urination
This combination of symptoms can indicate a severe infection or inflammation that needs treatment immediately.
Gallbladder diet
Previously, doctors thought a low-fat diet could help treat gallstones, or at least prevent their development.
New evidence, however, has debunked this approach, suggesting that losing too much weight too quickly could even result in gallstones becoming larger rather than shrinking.
A healthy diet that includes a variety of foods does not cure gallstones, but it will keep any discomfort caused by gallstones under control and improve good health and wellbeing.
The National Diabetes and Digestive and Kidney Diseases Institute recommends:
- eating high-fiber foods, such as beans, peas, fruits, whole grains, and vegetables
- reducing carbohydrate and sugar intake
- consuming fats that are good for you, for example, the fats found in fish oil and olive oil
Diagnosis
If a doctor suspects a patient has a problem with the gallbladder they will probably order the following:
- Imaging tests of the gallbladder: Ultrasound and CT scans are commonly used to image the gallbladder. These will then be checked for gallstones.
- Tests to examine bile ducts: These tests use dye to show if a gallstone is causing a blockage in the bile ducts. Tests to check the bile ducts for stones include MRI, hepatobiliary iminodiacetic acid (HIDA) scans, and an endoscopic retrograde cholangiopancreatography (ERCP).
- Blood tests: Doctors can use blood tests to reveal signs of infection, inflammation of the bile ducts, pancreatitis, or other complications caused by gallstones.
Treatment
Gallstones and cholecystitis are diseases which are treatable.
Gallstones that do not cause symptoms may require no immediate care other than an warning to any future issues with the gallbladder.
Gallstones that cause gallbladder symptoms or infections do need treatment, however.
Treatment options include surgically extracting the gallbladder, gallstone breakdown medications, and infection-treating antibiotics.
Removal
Gallbladder removal surgery is one of the most frequently performed surgeries, according to the University of California , San Francisco (UCSF).
Removal of the laparoscopic gallbladder (keyhole surgery) is most routine. A physician inserts a thin tube with a tiny video camera attached to a small incision in the abdomen, in this procedure. The camera transmits images from inside the body to a video display.
The surgeon slowly extracts the gallbladder from one of the small incisions while watching the enlarged pictures on the monitor.
Most removals of the gallbladder occur like this. These surgeries are often outpatient procedures, which means the patient is often allowed to go home the same day.
A much smaller number of patients suffering from gallbladder require open surgery. During open surgery, the gallbladder is removed by a 4-6-inch incision in the abdomen by an operator.
Sometimes such procedures occur when the gallbladder is too inflamed or contaminated for laparoscopic removal or when a condition arises during a laparoscopic operation. It is not an ambulatory procedure, and can require a hospital stay of up to 1 week later.
If a person is too ill to undergo surgery, drainage of the gallbladder may take place with a tube. The doctor inserts a tube into the gallbladder straight through the skin.
Prevention
Although it is not possible to avoid gallbladder problems entirely, people should take measures to reduce the chances of getting gallstones or other infections.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that there is an increased risk for gallstones in the following people:
- women
- people over 40
- people with a family history of gallstones
- native and Mexican Americans
- individuals with obesity
If a person falls into a category that increases the risk of gallstones, they should avoid the following to reduce their risk:
- rapid weight loss
- diets high in calories but low in fiber
- excess weight gain
Outlook
Problems with gallbladder are generally easy to resolve.
Long-term complications following removal of the gallbladder or treatment of the infection are unlikely. Upon recovery, those without a gallbladder can lead regular, healthy lives.
