Most people don’t pay much attention to this organ until it begins to cause problems.
However, when there is a problem, it can be quite painful and requires 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 fluid made by the liver to digest fats.
When the stomach and intestines digest food, the gallbladder releases bile through a tube called the common bile duct. This duct connects the gallbladder and liver to the small intestine.
In a healthy gallbladder, this process occurs painlessly. However, when the gallbladder stops working properly or the bile ducts become blocked, it can cause a lot of pain and discomfort.
The gallbladder is more likely to cause problems if something blocks the flow of bile through the bile ducts. That usually happens with gallstones. Stones form when there are substances in the bile that harden. Less commonly, gallbladder cancer can develop.
Many gallbladder problems are solved by removing it. Fortunately, the gallbladder is not an essential organ for life. Bile has other ways to get to the small intestine.
This article looks at what the gallbladder does, some common gallbladder conditions and their symptoms, treatment options, and long-term outlook.
Common causes and problems
The gallbladder is located just below the liver. Its job is to store the bile used to digest fat.
Some common gallbladder problems include:
Gallstones or colelithiasis
Gallstones are solid masses of cholesterol (or pigment) of different sizes. Gallstones occur when high levels of fat and bile cause crystals to form. These crystals can combine over time and expand into stones.
The stones can be as small as a grain of sand or as large as a golf ball. They may or may not cause symptoms.
Common bile duct stones or choledocholithiasis
Bile is transported from the gallbladder through small tubes and is deposited in the common bile duct. From there, it moves to the small intestine. Sometimes gallstones can lodge or form in the common bile duct.
Most often, these stones begin life in the gallbladder and migrate to the common bile duct; This is known as a secondary stone or secondary common bile duct stone.
If the stone forms within the duct itself, it is called a primary stone or primary common bile duct stone. These are less common, but more likely to cause an infection than secondary stones.
Gallbladder cancer is very rare, affecting fewer than 4,000 Americans per year; But if it occurs, it can spread to other parts of the body.
Risk factors include:
- Porcelain gallbladder (described below).
- Female gender
- Obesity and old age.
- Inflamed gallbladder
Acute or sudden cholecystitis occurs when bile cannot get out of the gallbladder. This commonly occurs when a gallstone blocks the tube that bile uses to enter and exit the gallbladder.
Chronic cholecystitis occurs if there are recurrent acute attacks.
When the bile duct is blocked, bile builds up. Excess bile irritates the gallbladder, leading to inflammation and infection. Over time, the gallbladder is damaged and can no longer fully function.
If gallstones are not treated, they can lead to a perforated gallbladder; in other words, a hole may develop in the wall of the organ. Perforation also occurs as a complication of acute cholecystitis.
This gap in the wall of the gallbladder can allow the infection to leak to other parts of the body and cause a serious and widespread infection.
Common bile duct infection
If the common bile duct becomes blocked, it can lead to an infection. This can be treated if caught early; however, if forgotten, it can spread and become a serious and life-threatening infection.
Dysfunctional gallbladder or chronic gallbladder disease
Repeated episodes of gallstone attacks or cholecystitis can permanently damage the gallbladder. This can lead to a stiff and scarred gallbladder.
In this case, the symptoms can be difficult to pin down. They include abdominal fullness, indigestion, and increased gas and diarrhea.
Gallstone ileus is rare, but can be fatal. It occurs when a gallstone migrates to the intestine and blocks it. Emergency surgery is often 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.
People with diabetes, reduced immune systems and obesity have a higher risk of developing this complication.
Porcelain gallbladder (calcified)
Porcelain gallbladder is a condition in which, over time, the muscular walls of the gallbladder develop a build-up of calcium. This makes them stiff, which limits gallbladder function and increases 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 generally benign (not cancerous). Smaller gallbladder polyps often do not cause any problems and rarely cause any symptoms. Larger polyps may need to be removed.
Symptoms of gallbladder problems include:
- Pain in the middle or upper right section of the abdomen: Most of the time, gallbladder pain comes and goes. However, the pain of gallbladder problems ranges from mild and irregular pain to very severe and frequent. Gallbladder pain often causes chest and back pain.
- Nausea or vomiting: Any gallbladder problem can cause nausea or vomiting. Long-term gallbladder diseases and disorders can lead to long-lasting digestive problems that cause frequent nausea.
- Fever or chills: This indicates an infection in the body. Along with other gallbladder symptoms, fever and chills can indicate a gallbladder problem or infection.
- Changes in bowel movements: Gallbladder problems often cause changes in bowel habits. Frequent and unexplained diarrhea can indicate chronic gallbladder disease. Light-colored or chalky stools may indicate a problem with the bile ducts.
- Changes in urine: Patients with gallbladder problems may notice urine that is darker than normal. Dark urine may indicate a bile duct blockage.
- Jaundice – The yellowing of the skin occurs when bile from the liver does not successfully reach the intestines. This usually occurs 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 doesn’t need immediate attention. However, patients with this type of pain should make an appointment with their doctor for further examination.
If symptoms are more severe and include the following, a patient should be seen immediately:
- Pain in the right upper quadrant that does not go away in 5 hours.
- Fever, nausea, or vomiting.
- Changes in bowel movement and urine.
This combination of symptoms may indicate a serious infection or inflammation that needs immediate treatment.
It was previously thought that a low-fat diet could help treat gallstones or at least prevent their growth.
However, this approach to treatment has been discredited by new evidence suggesting that losing too much weight too quickly may even lead to gallstones getting larger rather than shrinking.
A balanced diet that includes a variety of foods will not cure gallstones, but it can preserve health and overall health, keeping gallstone pain under control.
It is recommended :
- Eat foods rich in fiber : such as beans, peas, fruits, whole grains and vegetables
reduce the consumption of carbohydrates and sugar.
- Eat fats that are good : for example, the fats found in fish oil and olive oil.
If a doctor suspects that a patient has a gallbladder problem, they will likely order the following:
Gallbladder Imaging Tests : Ultrasound and CT scans are commonly used to image the gallbladder. They will then be checked for gallstones.
Tests to examine the bile ducts : These tests use dye to show if a gallstone is causing a blockage in the bile ducts.
Tests to detect stones in the bile ducts include:
- Magnetic resonances.
- Hepatobiliary iminodiacetic acid scans.
- Endoscopic retrograde cholangiopancreatography.
- Blood tests : Doctors may use blood tests to look for signs of infection, inflammation of the bile ducts, pancreatitis, or other complications caused by gallstones.
Most gallbladder removals are done using a laparoscope, a thin tube with a small camera attached.
Gallstones and cholecystitis are treatable conditions. Gallstones that do not cause symptoms do not need immediate treatment other than an alert of possible future gallbladder problems. However, gallstones that cause gallbladder symptoms or infections need treatment.
Treatment options include surgical removal of the gallbladder, medications to break up gallstones, and antibiotics to treat infections.
Gallbladder removal surgery is considered to be one of the most commonly performed surgeries.
Laparoscopic removal of the gallbladder (keyhole surgery) is the 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 looking at the magnified images on the monitor, the surgeon carefully removes the gallbladder through one of the small incisions. Most gallbladder removals are done this way.
These surgeries are often outpatient procedures, which means 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 occur when the gallbladder is too swollen 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 later.
If a person is too sick to tolerate surgery, the gallbladder can be drained with a tube inserted through the skin directly into the gallbladder.
While gallbladder problems cannot be completely prevented, patients can take steps to lower the risks of developing gallstones or other infections.
Specialists note that the following people are at 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.
- Excessive weight gain
Gallbladder problems are usually easily resolved. Long-term complications are unlikely after removing the gallbladder or treating the infection.
Those without a gallbladder can lead normal, healthy lives after recovery.