Gallbladder disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 27, 2016
StartDiseasesGallbladder disease

The gallbladder's function is to assist the liver by storing the bile used for digesting fat. Diseases of the gallbladder include gallbladder cancer, gallstones, and cholecystitis in which the gallbladder becomes inflamed.

Contents

Definition & Facts

During digestion, the gallbladder keeps bile flowing through the common bile duct that travels from the liver to the small intestine. A properly functioning gallbladder empties completely and often.

If something blocks this duct anywhere along the way, it can cause the liver and gallbladder to malfunction. Unhealthy foods, overeating, and other factors may cause the gallbladder to malfunction. Any malfunction can cause gallstones and related diseases.

Gallbladder rupture, severe diarrhea, weak bones, and organ failure are possible outcomes of untreated gallbladder disease. Although gallbladder cancer is rare, around 25 million Americans can expect to have gallstones. Gallbladder-related illnesses result in $6 billion in spending on U.S. health care each year.

Symptoms & Complaints

Symptoms of gallbladder trouble may at first feel like typical indigestion after a heavy meal. The pain can range from mild and intermittent to constant and severe.

Gallbladder pain is usually concentrated in the middle to upper right areas of the abdomen. It also has a tendency to travel to the right shoulder, back and neck, especially after fried or fatty foods are digested.

Many patients complain of chronic neck pain or neck stiffness and even visit chiropractors before discovering that their gallbladders are the cause. Nausea and vomiting are not uncommon symptoms of gallbladder diseases, and chronic cases are marked by excess gas or acid reflux.

High grade fever indicates an infection of some sort. Dark urine, loose stools, stools light in color, and diarrhea are all signs of blockage in the common bile duct. Jaundice is not unusual. Loss of appetite or sudden, unexplained weight loss should also raise a red flag.

Causes

Bile salts, cholesterol, calcium or other substances can harden and form gallstones. Some are as tiny as a grain of sand, but others may be over an inch in diameter. Blockage in the opening to the gallbladder can cause a buildup of bile and subsequent inflammation, a condition called cholecystitis.

Cholestasis occurs when bile flow to the intestines is slowed down or altogether stopped. This condition can cause acalculous cholecystitis which has symptoms similar to cholecystitis but without the presence of gallstones. Acalculous cholecystitis may also be caused by hepatitis A in rare cases.

Other issues include bile duct stones forming in the common bile duct after bile has left the gallbladder, leading to infection.

Like many other medical conditions, gallbladder diseases tend to run in families. More women than men develop problems, and people aged 60 or older are also at higher risk. Other causes and risk factors include the following:

Diagnosis & Tests

Diagnosing gallbladder disease starts with a thorough discussion of symptoms, diet and medical history. Following that, the doctor will perform an abdominal exam. This usually includes a special test to trigger Murphy’s sign if it exists. While the patient exhales, the doctor places a hand (palpation) over the upper right section of the abdomen where the gallbladder lies. The patient then inhales. If he or she winces or gasps in pain, the organ is probably tender and sore. The test is likely positive if repeating it on the left side of the body doesn’t result in pain.

Blood tests may reveal poor liver function or a high white blood cell count. X-rays and other medical imaging examinations may also be taken; if abdominal stones are largely calcium, they will be apparent in the images.

Medical ultrasounds, the most common means of diagnosing gallbladder ailments, use sound waves to produce pictures. Thickening of organ walls, stones and other problems are evident in ultrasonography. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are additional imaging studies that can reveal abnormalities in the structure and function of gallbladders.

Treatment & Therapy

Fortunately, gallstone episodes are usually one-time events. Almost half of all patients report that their stones eventually dissolved or dislodged on their own. If the pain is tolerable, doctors may advise patients to adopt a watchful waiting approach in which they wait and see if symptoms subside before pursuing treatment.

An acute case of gallbladder inflammation can usually be handled with antibiotics and pain management. If either of these conditions becomes chronic, however, gallbladder removal is recommended – a procedure called cholecystectomy.

Open abdominal surgery isn’t necessarily the only option. If the illness is not life-threatening, most surgeons prefer laparoscopy. A fiber-optic instrument is used, and recovery and scarring are minimal. Doctors sometimes put off surgery because of other health concerns, but patients should keep in close touch with their caregivers and report new or recurring symptoms.

There are noninvasive techniques to remedy gallstones but no guarantee that new stones won’t form. The drug, ursodeoxycholic acid (ursodiol), a bile acid, is one example. It dissolves gallstones formed from cholesterol, but patients with recurring episodes or very large stones may have to stay on it indefinitely.

Shock wave therapy and medical dissolution are still being studied. The first uses sound waves to blast gallstones; the second involves injecting a drug directly into the organ through the use of a catheter.

Prevention & Prophylaxis

Eating healthy maintaining a healthy weight have been shown to decrease the likelihood of forming gallstones and to ease discomfort when they do occur.

According to some studies, avoiding refined grains, sugar, dairy products and fried foods may prevent problems. Instead, doctors recommend plenty of fresh fruits and vegetables; fish, poultry and lean meat; and whole grains like oats and brown rice. Early research also indicates that drinking caffeinated coffee in moderation may reduce the risk of gallstones.

People who want to lose weight should try to shed pounds gradually. Crash dieting and rapidly gaining and losing weight can cause gallstones. One should aim to not lose more than three pounds per week as this can result in gallstones.