Gallbladder Problems

The gallbladder, a pear-shaped organ about four inches long, is located under the liver. It’s responsible for storing bile — a fluid that helps break down fats from food. When people eat, the gallbladder contracts to release bile into the small intestine.

Gallbladder problems are common and are a type of digestive health disorder.

More than 20 million Americans have gallbladder disease, and a little over 14 million of those people are women, according to Cleveland Clinic. Each year, surgeons remove more than 600,000 diseased gallbladders in a surgery called cholecystectomy.

Depending on the specific problem, health care providers may recommend over-the-counter pain relievers, prescription pain medications or gallbladder removal.

Gallstones, also called cholelithiasis, are the most common gallbladder problem. These “stones” can range in size from as small as grains of sand to as large as golf balls, according to the National Institute of Diabetes and Digestive and Kidney Diseases. They are made of hardened cholesterol or bilirubin, a yellowish substance in the blood that forms after red blood cells break down.

At some time in their lives, 10 to 15 percent of adult Americans will develop gallstones — approximately 20 to 25 million people.

Up to 80 percent of people with gallstones will never experience symptoms. These stones are called “silent” gallstones and don’t typically need treatment.

If gallstones grow or increase in number, they may cause pressure when the gallbladder contracts. Pain in the upper right abdomen called biliary colic is the most common symptom. Nausea and vomiting may also occur.

Symptomatic gallstones can cause serious problems if left untreated. These include pancreatitis, infections of the bile ducts or liver and gallbladder inflammation. Dark urine, jaundice or light, clay-colored stools are a sign that a stone blocks the common bile duct.

The most common treatment for gallstones is cholecystectomy, or gallbladder removal surgery.

Cholecystitis is inflammation of the gallbladder and can be chronic or acute. It’s the most common complication of gallstones and occurs when a gallstone blocks the bile duct.

These disorders are serious and most often require hospitalization.

Acute and Chronic Cholecystitis

About 95 percent of people with acute cholecystitis have gallstones, according to the Merck Manual. The first sign of acute cholecystitis is pain in the upper right part of the abdomen.

The pain is sudden, severe and constant. It often radiates to the back or right shoulder blade. An attack may last for 2 to 3 days. About one third of people with acute cholecystitis may have a fever above 100.4 degrees accompanied by chills.

If the pain gets worse and the fever gets higher, pockets of pus or a tear may have formed in the gallbladder wall. If a stone escapes the gallbladder, it may block the small intestine.

People with chronic cholecystitis have recurring pain attacks in the upper right abdomen. They rarely have fevers, and their pain episodes are shorter and less severe than in acute cholecystitis.

Empyema of the Gallbladder

The most serious form of acute cholecystitis is called gallbladder empyema. This happens when the bile ducts are blocked and bile becomes stagnant. Microorganisms in the bile cause a serious infection that fills the gallbladder with pus.

This condition occurs in 5 to 15 percent of acute cholecystitis. The risk is higher in people with diabetes or immunosuppressant therapy.

This serious condition requires emergency care with antibiotics and gallbladder removal.

Acalculous Cholecystitis

Acalculous cholecystitis occurs in people who have no signs of gallbladder disease. It starts with sudden, excruciating pain in the upper abdomen caused by gallbladder inflammation. This may lead to rupture or gangrene of the gallbladder.

The only symptoms may be a fever and a distended, swollen abdomen. This condition typically occurs in very ill people who may already be hospitalized for other reasons. Without treatment, it can be fatal in about 65 percent of people.

Gallstones and cholecystitis are the most common problems, but a handful of other rarer issues can also affect the gallbladder.

Gallstone Ileus

Gallstone ileus occurs when a gallstone blocks the small intestine. It’s one of the rarest forms of bowel obstruction and is a rare complication of gallstones. Only about 0.3 to 0.5 percent of people with gallstones suffer this complication.

While rare, this condition can be fatal in 15 to 30 percent of people if left undiagnosed and untreated, according to the U.S. National Library of Medicine.

Porcelain Gallbladder

Porcelain gallbladder occurs when the gallbladder wall calcifies and becomes brittle and bluish in color. About 95 percent of people with this condition have gallstones. It happens more often in women and is usually diagnosed in people 60 and older.

Cancer and Polyps

Gallbladder cancer is rare in the United States. In fact, there are fewer than 5,000 cases each year. But it is an aggressive cancer and many people only survive a few months after diagnosis. Only 5 percent of people survive for 5 years.

People with a history of gallstones and gallbladder inflammation have the highest risk of developing this cancer. Larger size stones or a greater number of gallstones also increase the risk.

About 5 percent of people develop gallbladder polyps. These are mostly asymptomatic, non-cancerous masses. But large polyps greater than 10 mm in size might be signs of cancer and should be removed.

The most common gallbladder disease symptom is pain. It can spread to the shoulder and back and get worse when breathing. It becomes sharp when the upper right abdomen is pressed.

Gallbladder attacks may last a few minutes to several days. They usually happen after eating a fatty meal and are more likely to occur at night.

There is no relationship between gallbladder problems and acid reflux or GERD, but some of the symptoms may overlap. Patients should check with their health care providers as a precaution.

Researchers don’t know exactly what causes gallbladder problems. But the theory is that too much cholesterol, bilirubin or not enough bile salts may cause gallstones. Stones may also form if the gallbladder doesn’t empty enough.

Certain people may also have increased risk factors for gallbladder problems. Some factors such as lifestyle and weight can be prevented, while others such as ethnicity and family history cannot.

Some studies show that some diseases may increase the risk of gallstones. For example, one 2017 study by Dr. Yo Han Jeong and colleagues published in Medicine found that patients with ulcerative colitis have a significantly higher risk of developing gallstones.

Some prescription medications may increase gallbladder disease risk. For example, a 2011 study in the Canadian Medical Association Journal found that women who took the birth control pill Yaz had a 20 percent increase in the risk of gallbladder disease.

Authors said it was a “small, statistically significant increase in the risk of gallbladder disease.”

Other drugs that may increase gallbladder problems include the synthetic hormone octreotide, an antibiotic called ceftriaxone and thiazide diuretics.

Health care providers may order a few different tests to check for gallbladder problems.

Lab Tests

Blood samples can show signs of inflammation or infection. High liver or pancreas enzymes can also signal a gallbladder problem.

Ultrasound

An ultrasound is typically the first kind of imaging test a health care provider will order. It works by bouncing sound waves off organs to create an image. It’s safe, painless and non-invasive. It works well to find gallstones and can even detect gallstones with no symptoms.

Computed Tomography (CT) Scan

CT scans are not as accurate at finding gallstones as an ultrasound. These scans use computer technology and x-rays to create images of the bile ducts, gallbladder and pancreas. It is helpful for finding blockages and infections.

Magnetic Resonance Imaging (MRI)

MRIs work without x-rays. Instead, they use magnets and radio waves to make images of soft tissues and organs. They are good for detecting gallstones in the bile ducts.

Hydroxy Iminodiacetic Acid Scan (HIDA Scan, Hepatobiliary Scan)

During a HIDA scan, a health care provider injects the patient with radioactive material through the arm. This material will help visualize the bile ducts and the gallbladder. Sometimes, the health care provider will also inject a substance that causes the gallbladder to contract so they can see how well it’s working.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is an invasive procedure where health care providers insert a special, snake-like endoscope into the body. The scope has a camera and instruments at the end of it. It is able to locate any bile duct blockages and remove them.

Most gallbladder problems, such as gallstones, are highly treatable. The first choice is often surgery, but there are also non-surgical treatments that a health care provider can recommend.

Medications

If gallbladder pain is mild and there is no blockage, a provider may recommend over-the-counter pain relievers or prescription pain relievers.

Actigall (ursodiol) and Chenix (chenodial) are two bile acid drugs that may break up gallstones. But it often takes months or years to break up stones. The stones may also reoccur.

Doctors may sometimes use a type of shockwave therapy called lithotripsy to break up gallstones along with one of the drugs. However, this procedure is rare because of high gallstone recurrence rates.

Cholecystectomy (Gallbladder Removal)

A cholecystectomy is gallbladder removal surgery. The most common type of surgery is a laparoscopic cholecystectomy. Patients receive general anesthesia and the procedure takes one to two hours.

The surgeon will make a few small holes in the abdomen and insert surgical tools and a lighted camera. Doctors also inflate the abdomen with a harmless gas to better see the organs. After the gallbladder is removed, the surgeon closes the small holes.

Some surgeons may use a power morcellator to chop up the gallbladder and remove it though the small incision in the abdomen. The patient can usually go home the same day and the recovery time is quicker.

In an open cholecystectomy, the surgeon makes a larger incision and cuts through fat and muscle to remove the gallbladder. Recovery takes longer and there are more risks of complications.

Gallbladder health is important for a well-functioning digestive system. Diet, lifestyle and weight play a role in preventing gallstones.

What to Eat After Gallbladder Removal

People who have their gallbladders removed may have to watch what they eat. Eating high-fat or high-fiber foods could lead to diarrhea, cramping and bloating. Avoid high-fat foods and slowly reintroduce fibrous foods like vegetables.

Cleveland Clinic recommends keeping fat calories to less than 30 percent of your calorie intake. This typically means checking labels for foods with more than 3 grams of fat per serving. Eating a balanced diet is important to recovery and overall health because an estimated 70 percent to 80 percent of immune cells live in the gut.

Patients should also go over all medication with their health care provider. Some drugs may cause issues for people without a gallbladder. For example, people without a gallbladder who take the irritable bowel syndrome drug Viberzi may have an increased risk of pancreatitis.