There are a number of problems that can affect the gallbladder. This article looks at types of gallbladder disease, how they are diagnosed, treatment options, and prevention tips.
Types of gallbladder disease
Here are some common conditions that can affect the gallbladder:
Gallstones are small stones made up of cholesterol that has become solid.
Gallstones often go unnoticed and don't cause any problems. However, if they are large, they can become trapped in an opening or "duct" inside the gallbladder. This can result in a sudden pain in the upper body called biliary colic.
Biliary colic tends to come on after eating foods that contain a lot of fat, although it can occur at other times of day or night. The pain that is felt in the upper part of the torso is continuous and accompanied by a feeling of sickness and sometimes heavy sweating.
The pain isn't made better by going to the toilet, vomiting, or passing wind. An episode can last for anything from 1 to 5 hours, and it's possible not to have another one for several weeks or months.
A diagnosis is made after a doctor's physical examination. Ultrasound can be used to detect gallstones and, for long-lasting symptoms, blood tests can also be done.
A more severe gallstone blockage inside a bile duct can produce swelling in the gallbladder. This condition is called cholecystitis and, if left untreated, can lead to serious complications.
There are two types of cholecystitis: acute and chronic.
This comes on as sudden, intense pain with nausea, vomiting, and fever. The pain can last from 6 to 12 hours, or longer. An episode of acute cholecystitis usually clears within a week. If it doesn't, it may be a sign of something more serious.
According to the Merck Manual, 95 percent of acute cholecystitis cases are caused by gallstones. However, acute cholecystitis can be the result of conditions that aren't linked to gallstones.
There is a form of acute cholecystitis that occurs without gallstones. It can appear after major surgery or critical illnesses, or be the result of infection or a weak immune system. People with this form of cholecystitis become very ill. The inflammation can become so severe that it can result in rupture of the gallbladder.
A swollen gallbladder may need to be removed with surgery.
Chronic cholecystitis is the result of long-term inflammation in the gallbladder. It is caused either by gallstones or previous episodes of acute cholecystitis.
Someone with this type of cholecystitis will experience repeated episodes of upper body pain and sudden inflammation. They will also experience less pain compared with someone with acute cholecystitis and will rarely experience a fever.
Cholecystitis can have a number of serious complications. These include:
- Gallbladder infection: If cholecystitis is caused by a build-up of bile, the bile may become infected.
- Death of gallbladder tissue: If untreated, cholecystitis can cause gallbladder tissue to die. Dead tissue can result in a torn or burst gallbladder.
- Torn gallbladder: A tear in the gallbladder can also be caused by gallbladder swelling or infection.
Both forms of cholecystitis can have life-threatening consequences if left untreated, and so an early diagnosis is essential.
Diagnosis of gallbladder disease
A doctor will make a diagnosis from the symptoms described by the patient and a physical examination. Ultrasound can be used to detect gallstones, fluid around the gallbladder, and thickening walls.
For persisting symptoms, blood tests can also be done. Imaging tests are carried out when acute cholecystitis is hard to diagnose or doctors suspect cholecystitis without gallstones.
Treatment of gallbladder disease
People with a form of cholecystitis need hospital treatment. The aim is to control the symptoms and reduce inflammation in the gallbladder. This involves fasting to ease the stress on an inflamed gallbladder.
Fluids are fed into the veins to avoid dehydration.
A doctor may also prescribe antibiotics to fight infection and pain medication to relieve the pain of inflammation. Symptoms are likely to improve within a couple of days.
An inflamed pancreas can also block the bile ducts.
In more complicated cases, surgery may be required. Surgery to remove the gallbladder is called a cholecystectomy and is a common procedure. In most cases, the patient will be able to go home the same day.
In chronic cholecystitis, removal of the gallbladder usually takes place once an episode subsides.
Surgery may be required within 48 hours if:
- The patient has acute cholecystitis and surgery does not pose a risk
- The patient is old or has diabetes
- A doctor suspects a complication such as an abscess or gangrene
- The patient has cholecystitis with gallstones
If surgery is too risky because of other health issues such as heart, lungs or kidney conditions, it can be postponed until treatment for such conditions is under control.
Preventing gallbladder disease
Preventing gallstones reduces the risk of cholecystitis and can be done by:
- Maintaining a healthy weight through proper diet and keeping fit
- Avoiding rapid weight loss
- Eating a healthy diet that's low in fat and high in fiber
Diet before and after surgery
A diet that's low in fat is often recommended several weeks before surgery. Most people don't need to follow a special diet afterward and can usually start eating normally after a few hours. It's better, however, to begin eating small meals.
Some side effects from the surgery are indigestion, bloating, flatulence, and diarrhea. These may be eased by avoiding caffeinated drinks and spicy or fatty foods. Fiber intake should be increased gradually.
In general, eating a good, balanced diet is important for staying healthy. The British Liver Trust recommend eating plenty of fruit, vegetables, and high-fiber foods such as wholemeal bread and pasta. They also recommend avoiding salty foods and eating a low-fat, low-cholesterol diet.
Living without a gallbladder
As the gallbladder is not an essential organ, a person can lead a normal life without one. Bile will still find its way to the small intestine via other ducts in the liver instead of being stored in the gallbladder.
Other problems affecting the bile ducts
There are other diseases that affect the bile duct:
Primary biliary cirrhosis (PBC)
This condition involves inflammation of the bile ducts in the liver with increasing scarring. It begins with inflammation that blocks the flow of bile out of the liver. The bile becomes trapped in the liver cells causing inflammation.
Over time, inflammation causes the liver to become scarred, leading to cirrhosis and liver failure.
Primary sclerosing cholangitis (PSC)
Scarring due to inflammation causes narrowing and blocking of the bile ducts, eventually leading to cirrhosis. As a result, bile salts that help the body absorb fats are not expelled normally.
PSC is similar to PBC. The difference is that PSC affects the bile ducts outside the liver as well as those in the liver. The cause is unknown but is likely to be due to the immune system attacking the body.
Tumors of the bile duct and gallbladder
Cancer of the bile ducts or gallbladder is rare. Being older or having PSC increases the risk of developing this cancer.
Pancreatitis and pancreatic tumors
Pancreatitis is the inflammation of the pancreas. The condition can be caused by gallstones, certain viral infections, digestive enzymes, alcohol and some drugs.
Many pancreatic tumors can block the bile ducts through which the bile leaves the liver.
Impact of other conditions on the gallbladder
Other conditions that can affect the gallbladder are: