Most people do not pay much attention to their gallbladder until it starts causing trouble. However, when there is a problem, it can be quite painful and require immediate action.
The gallbladder is a 4-inch-long, pear-shaped organ found under the liver in the upper right region of the abdomen. It stores bile, a compound produced by the liver to digest fat, and helps the body absorb fat-soluble vitamins and nutrients.
In a healthy gallbladder, this process happens painlessly. However, when blockage occurs in the gallbladder, or it stops functioning correctly, considerable pain and discomfort can occur.
In this article, we look at the function of the gallbladder, some common gallbladder problems and their symptoms, treatment options, and the long-term outlook.
Some common gallbladder problems include:
Gallstones, or cholelithiasis
They occur when high levels of fat and bile cause crystals to form. These crystals may combine over time and expand into stones.
Stones can be as small as a grain of sand or as large as a golf ball and may or may not cause symptoms.
Common bile duct stones, or choledocholithiasis
Small tubes transport bile from the gallbladder and deposit it in the common bile duct. From there, it is moved to the small intestine. Sometimes, gallstones can lodge or form in the common bile duct.
Most often, these stones begin their life in the gallbladder and migrate to the common bile duct. This is a secondary stone or a secondary common bile duct stone.
If the stone forms within the duct itself, it is a primary stone, or primary common bile duct stone. These are less common but are more likely to cause an infection than secondary stones.
Risk factors include gallstones, porcelain gallbladder (described below), female gender, obesity, and older age.
Inflamed gallbladder, cholecystitis
Acute or sudden cholecystitis occurs when bile can't leave the gallbladder. This commonly happens when a gallstone obstructs the tube that bile uses to travel into and out of the gallbladder.
Chronic cholecystitis occurs if there are recurrent acute attacks.
When the bile duct is blocked, bile builds up. The excess bile irritates the gallbladder, leading to swelling and infection. Over time, the gallbladder is damaged, and it can no longer function fully.
If gallstones are left untreated, they can lead to a perforated gallbladder - in other words, a hole in the wall of the organ can develop. Perforation also occurs as a complication of acute cholecystitis.
This breach in the gallbladder's wall can allow leakage of infection into other parts of the body causing a severe, widespread infection.
Common bile duct infection
If the common bile duct becomes blocked, it can lead to an infection. This can be treated if it is caught early; however, if it is missed, it can spread and develop into a severe, life-threatening infection.
Dysfunctional gallbladder or chronic gallbladder disease
Repeated episodes of gallstone attacks or cholecystitis may damage the gallbladder permanently. This can lead to a rigid, scarred gallbladder.
Gallstone ileus is rare but can be fatal. It occurs when a gallstone migrates to the intestine and blocks it. Often, emergency surgery is needed to clear the blockage.
Sometimes, a patient with gallstones will also develop pus in the gallbladder; this is called empyema. The condition can produce severe pain in the abdomen. It can be life-threatening if it is not treated.
Individuals with diabetes, reduced immune system, and obesity have an increased risk of developing this complication.
Porcelain (calcified) gallbladder
Porcelain gallbladder is a condition where, over time, the muscular walls of the gallbladder develop a buildup of calcium. This makes them stiff, limiting the gallbladder's function and increasing the risk of gallbladder cancer.
The word "porcelain" is used because the organ becomes bluish and brittle.
Polyps are a type of growth that is typically benign (noncancerous). Smaller gallbladder polyps often do not cause any problems and rarely produce any symptoms. Larger polyps may need to be removed.
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
Anyone with gallbladder symptoms should seek medical attention. Mild, intermittent pain that goes away on its own does not need immediate attention. However, patients with this type of pain should make an appointment with their doctor to be examined further.
If the symptoms are more severe and include the following, a patient should be seen immediately:
- 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 serious infection or inflammation that needs immediate treatment.
Doctors previously thought that a low-fat diet could assist with treating gallstones or at least preventing their growth.
However, new evidence has debunked this approach, suggesting that losing too much weight too rapidly might even lead to gallstones becoming larger rather than shrinking.
A balanced diet that includes a variety of foods will not cure gallstones, but it can preserve overall health and health keep any pain caused by gallstones under control.
The National Institute of Diabetes and Digestive and Kidney Diseases recommends:
If a doctor suspects a patient has a gallbladder problem, they will likely 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.
Gallstones and cholecystitis are treatable conditions.
Gallstones that do not cause symptoms will not need immediate treatment other than an alert for potential future gallbladder problems.
However, gallstones that cause symptoms or infections of the gallbladder do need treatment.
Treatment options include surgically removing the gallbladder, medications to break up gallstones, and antibiotics to treat infections.
According to the University of California San Francisco (UCSF), gallbladder removal surgery is one of the most commonly performed surgeries.
Laparoscopic gallbladder removal (keyhole surgery) is most common. In this procedure, a surgeon inserts a thin tube with a tiny video camera attached into a small incision in the abdomen. The camera transmits images from inside the body to a video monitor.
While watching the enlarged images on the monitor, the surgeon carefully removes the gallbladder through one of the small incisions.
Most gallbladder removals occur this way. These surgeries are often outpatient procedures, meaning that the patient can often go home the same day.
A much smaller number of gallbladder patients need open surgery. During open surgery, a surgeon removes the gallbladder through a 4-6-inch-long incision in the abdomen.
These surgeries often happen when the gallbladder is too inflamed or infected to remove laparoscopically or if a problem occurs during a laparoscopic procedure. This is not an outpatient procedure and may require a hospital stay of up to 1 week afterward.
If a person is too ill to tolerate surgery, gallbladder drainage with a tube is possible. The doctor inserts a tube through the skin directly into the gallbladder.
While the outright prevention of gallbladder problems is not possible, people can take steps to decrease the risks of developing gallstones or other infections.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) state that the following people have an increased risk of gallstones:
- 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