Gallbladder disease: What you need to know
Bile is a yellowish liquid made by the liver. It helps the body break down fat and get rid of waste.
A number of problems can affect the gallbladder.
Some common health issues that can affect the gallbladder are:
Abdominal pain can be a symptom of gallbladder disease.
Around 20 million people in the United States between the ages of 20 and 74 years have gallstones. Of these, 14 million are women.
There are often no symptoms, but gallstones can become trapped in an opening or duct inside the gallbladder.
This can result in a sudden pain in the abdomen, specifically between the rib cage and the belly button, just below the right ribs. The pain may spread to the side or the shoulder blade.
Other symptoms include:
- abdominal pain that lasts several hours
- nausea, vomiting, and loss of appetite
- a fever and chills
- a yellow tinge to the skin and the whites of the eyes
- dark-colored urine and pale stools
- itchy skin
- heavy sweating
A person may also feel contractions as the gallbladder tries to expel a gallstone.
Using the bathroom, vomiting, and passing gas do not improve the pain.
Eating foods that contain a lot of fat can trigger the discomfort — which doctors call biliary colic — but it can happen without a specific trigger.
A person who experiences this pain should see a doctor, as complications can result.
A more severe gallstone blockage inside a bile duct can cause swelling in the gallbladder. The name of this condition is cholecystitis.
If a person does not receive treatment, serious complications can arise.
Cholecystitis can be acute or chronic.
A person first experiences sudden, intense pain. The pain may last 6–12 hours or longer.
There may also be:
- nausea and vomiting
- a fever
- slight yellowing of the skin
- swelling in the abdomen
An episode of acute cholecystitis usually clears within a week. If it does not go away, it may be a sign of something more serious.
Cholecystitis often results from gallstones, but it can stem from other conditions.
If cholecystitis does not involve gallstones, it can appear:
- after major surgery
- after a critical illness
- as a result of an infection or a weak immune system
People with this form of cholecystitis can become very ill. If the inflammation is severe, it can result in a rupture of the gallbladder.
Chronic cholecystitis is the result of long-term inflammation in the gallbladder. This occurs when the gallbladder does not drain properly.
The underlying cause may involve:
- gallstones blocking a duct
- high concentrations of bile salt and calcium
- the gallbladder being unable to empty properly
- sickle cell anemia
Symptoms include repeated episodes of sudden inflammation and upper body pain. The pain will be less severe than that of acute cholecystitis, and a person usually will not have a fever.
Cholecystitis can cause a number of serious complications. These include:
Gallbladder infection: If cholecystitis results from a buildup of bile, the bile may become infected.
Death of gallbladder tissue: Without treatment, cholecystitis can cause gallbladder tissue to die, and gangrene can develop. Dead tissue can also cause the gallbladder to tear or burst.
Torn gallbladder: A tear in the gallbladder can result from swelling or infection.
Both forms of cholecystitis can have life-threatening consequences. It is important to seek medical aid if a person shows symptoms.
A doctor will ask about symptoms, and they may carry out some tests.
A doctor will ask the person about their symptoms and carry out a physical examination.
Also, an ultrasound can detect:
- fluid around the gallbladder
- thickening of gallbladder walls
If symptoms persist, blood tests can provide more information.
A doctor may recommend further imaging tests — such as a CT or MRI scan — if they are unsure of the diagnosis.
A person with either type of cholecystitis will need treatment in the hospital.
The aim is to:
- control the symptoms
- reduce inflammation in the gallbladder
Depending on how severe the symptoms are, the first steps may be:
- fasting, to ease stress on the inflamed gallbladder
- supplying intravenous fluids to prevent dehydration
A doctor may also prescribe:
- antibiotics to fight infection
- pain relief medication
Symptoms usually improve within a couple of days.
In some cases, a person may need surgery.
The name for a gallbladder removal is a cholecystectomy. It is usually a laparoscopic, or keyhole, surgery.
Surgeons consider this a routine procedure. Around 500,000 people have it each year in the U.S., and many go home the same day. Recovery takes about a week.
In a person with chronic cholecystitis, the surgeon will usually remove the gallbladder after an episode subsides.
A person may need surgery within 48 hours if:
- they have acute cholecystitis and surgery does not pose a risk
- they are older or have diabetes
- a doctor suspects a complication, such as an abscess or gangrene
- the person has cholecystitis with gallstones
If the surgery is risky because of other health issues, such as heart, lung, or kidney conditions, the doctor may postpone the procedure until the other problems are treated or managed.
The diet before and after surgery
After surgery, a person should follow a healthful diet, starting with small meals.
A doctor may recommend adopting a low-fat diet for several weeks before surgery.
Most people do not need to follow a special diet afterward. They can usually start eating as usual within a few hours of surgery.
It is better, however, to:
- begin with small meals
- avoid caffeinated drinks
- avoid fatty or spicy foods
- increase the fiber intake gradually
These steps can help reduce the side effects of surgery, which include:
In general, a balanced diet is important for staying healthy. This should include:
- plenty of fresh fruits and vegetables
- high-fiber options, such as wholemeal bread and pasta
- foods that are low in fat, salt, and sugar
Click here to find out more about what to eat for a healthy gallbladder.
Living without a gallbladder
The gallbladder stores bile, but it is not an essential organ, and a person can lead a regular life without one.
Bile will still find its way into the small intestine through ducts in the liver.
Preventing gallstones from forming reduces the risk of cholecystitis.
By eating a healthful diet and getting enough exercise, and thus maintaining a healthy weight, a person can help prevent gallstones.
It is important to avoid rapid weight loss and ensure that the diet is rich in fiber, full of fresh fruits and vegetables, and low in fat.
Other problems affecting the bile ducts
Some of these issues include:
Primary biliary cirrhosis
This involves inflammation of the bile ducts in the liver, with increasing scarring.
Primary biliary cirrhosis begins with inflammation that blocks the flow of bile out of the liver. The bile becomes trapped in liver cells and inflammation results.
Over time, recurring inflammation can lead to scarring in the liver, cirrhosis, and liver failure.
Primary sclerosing cholangitis
In this condition, inflammation leads to scarring, which causes the affected bile ducts to narrow and become blocked.
Primary sclerosing cholangitis (PSC) can also eventually lead to cirrhosis. When this happens, the body cannot expel the bile salts that help it absorb fats.
PSC is similar to primary biliary cirrhosis, except that it affects bile ducts outside and inside the liver. The cause is unknown but it likely results from the immune system attacking the body.
Tumors of the bile duct and gallbladder
Cancer of the bile duct or gallbladder is rare. Risk factors include older age and having PSC.
Pancreatitis and pancreatic tumors
Pancreatitis is inflammation of the pancreas.
It can result from:
- certain viral infections
- digestive enzymes
- some drugs
Pancreatic tumors can block the ducts through which bile leaves the liver.
Other problems affecting the gallbladder
The following can harm the gallbladder:
Crohn's and other intestinal diseases: These can change the way that the body absorbs nutrients.
Diabetes: This can increase the risk of gallstones.
Overweight or obesity: This can put a strain on the body and increase the amount of cholesterol in the bile, causing gallstones to form.
However, anyone thinking of losing weight for this reason should speak to a doctor first, because rapid weight loss can also cause gallstones.