Gallstones and Gallbladder Disease
- Also Known As:
- Gallstone Disease
- Biliary Disease
- Biliary Colic
- Schlerosing Cholangitis
What is the gallbladder and the biliary system?
The gallbladder is a small, pear-shaped organ located in your abdomen below the liver. Between meals, the gallbladder collects and stores bile, a digestive fluid made in the liver that contains bile salts and other substances that help digest fat from food. At mealtimes, the gallbladder contracts and releases bile into the small intestine to aid digestion. The thin series of tubes that move bile from the liver and the gallbladder…
The gallbladder is a small, pear-shaped organ located in your abdomen below the liver. Between meals, the gallbladder collects and stores bile, a digestive fluid made in the liver that contains bile salts and other substances that help digest fat from food. At mealtimes, the gallbladder contracts and releases bile into the small intestine to aid digestion. The thin series of tubes that move bile from the liver and the gallbladder to the intestines are called bile ducts and include:
- Cystic duct
- Hepatic duct
- Common bile duct
The gallbladder, along with the bile ducts connecting it to the liver and small intestine, are called the biliary system. The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gallbladder into the small intestine. The pancreas is a narrow, flat organ with a head, middle, and tail section. Its head section connects to the duodenum, the first part of the small intestine. The pancreatic duct carries digestive enzymes down the length of the pancreas and into the duodenum. The bile duct and pancreatic duct usually join just before entering the duodenum and share a common opening into the small intestine.
Gallbladder disease occurs when the gallbladder does not function properly. Most gallbladder problems occur when a gallstone blocks one of the bile ducts, causing symptoms such as severe abdominal pain and nausea. Gallbladder disease can also occur when something else causes a blockage, or with inflammation, infections, tumors and congenital defects. Sometimes a gallstone blocks the pancreatic duct, causing inflammation of the pancreas (pancreatitis).
Gallbladder Blockage and Disease
Gallstones are formed when substances, such as cholesterol, bile pigments and/or calcium salts, harden into a solid form. Gallstones can be as small as a grain of sand or as large as a golf ball.
In the U.S., gallstones affect 10-15% of adults under age 65 and 20% of people older than 65. Most of the time, gallstones do not cause symptoms. When gallstones block the cystic duct leading to the bile ducts, or the common bile duct itself, bile builds up in the gallbladder, causing pressure, swelling, and pain. Pain caused by gallstones is called biliary colic. It usually occurs in the upper abdomen or sometimes the right shoulder blade in the back and increases over a short period of time.
Other gallbladder blockages
Though gallstones are the most common source of gallbladder blockage, other conditions can prevent bile from moving within bile ducts. These include:
- Biliary sludge—when bile remains in the gallbladder for too long, microscopic bile particles can accumulate without forming stones. This biliary sludge can eventually form gallstones or pass into and block biliary ducts. Biliary sludge tends to form during pregnancy and usually disappears on its own.
- Viral infections—these can trigger gallbladder inflammation and can cause bile ducts to become inflamed and scarred, causing the ducts to narrow. Before the widespread availability of antiviral medications to treat HIV, this gallbladder condition affected 25% of people with HIV. Gallbladder disease due to viral infections is now rarely reported in developed countries, while remaining a problem in developing countries.
- Gallbladder cancer— this is a rare form of cancer. Gallstones are the most common risk factor for gallbladder cancer. Since a tumor can also block bile ducts, gallbladder cancer symptoms are similar to those of gallstones. Non-cancerous tumors and cancers of the pancreas can also block bile ducts.
Gallbladder inflammation (cholecystitis)
Uncomplicated gallbladder inflammation is very treatable. However, if left untreated, gallbladder inflammation can become severe. A bacterial infection can occur, requiring the affected patient to stay in the hospital to receive antibiotics. Untreated, severe inflammation can also lead to pancreatitis, gallbladder rupture, gangrene and sepsis.
When gallbladder blockage by gallstones or another obstruction persists, it can cause gallbladder inflammation called cholecystitis.
Cholecystitis can develop rapidly in a matter of hours (acute) or reoccur over a long period of time (chronic). Acute cholecystitis starts suddenly and causes severe pain in the upper abdomen that typically lasts for more than 6 hours.
Rarely, someone may develop acute gallbladder inflammation without evidence of a gallstone or other obstruction blocking the bile duct. This is a serious condition called acalculous cholecystitis. It can lead to a ruptured gallbladder or gangrene. It can be fatal if untreated.
Acalculous cholecystitis typically arises as a complication when someone is already quite ill. It can affect people who have had major surgery, a serious injury, severe burns, sepsis, undergone prolonged intravenous feeding, or when someone is immune deficient. Acalculous cholecystitis may be caused by sluggish bile movement, which can be brought on by fever and dehydration in critically ill people.
Acalculous cholecystitis accounts for 10% of gallbladder inflammation cases, while gallstones account for most of the remainder.
Gallbladder pain without gallstones
Sometimes people have gallbladder pain when there’s no apparent blockage of the bile duct. This pain can be caused by:
- A sensitive biliary tract or small intestine
- The muscle between the bile duct and small intestine not functioning
- Small, undetected gallstones passing through ducts
In some cases, the reasons for bile not leaving the gallbladder properly is unknown.
Congenital gallbladder disease
Sometimes infants are born with birth defects that prevent the gallbladder or bile ducts from working properly. For example, in biliary atresia, individuals are born with bile ducts that narrow and become blocked shortly after birth. This requires surgery to allow the bile to drain directly into the intestine and usually requires a liver transplant before age 20.
About Gallstones and Gallbladder Disease
Examples of risk factors for developing gallstones and gallbladder disease include:
- Female sex
- Older age (age 40 or older)
- High blood cholesterol levels
- Native American or Mexican American descent
- Treatment with estrogen-containing medication
- Family history of gallstones
- Rapid weight loss
- Sickle cell anemia or other types of hemolytic anemia
- Liver disease
- Sedentary lifestyle
- Rapid weight loss
- High-fat, high-cholesterol, and/or low fiber diet
- Cystic fibrosis
Signs and Symptoms
Gallstones are the most common cause of gallbladder disease, but the majority of gallstones do not cause any symptoms. They are often found by chance when someone has an abdominal X-ray or ultrasound to evaluate a different condition.
However, pain can occur in the abdomen if a gallstone blocks the flow of bile out of the gallbladder during contraction of the gallbladder. This is known as biliary colic. Signs and symptoms may include:
- Severe abdominal pain, especially at the top right side or center of the abdomen
- Pain that spreads to the back or right shoulder blade
- Nausea that occurs at the same time as abdominal pain
- Abdominal pain that is linked to eating a fatty meal (when the gallbladder contracts)
- Normally, the intense pain lasts at least 30 minutes but begins to subside within an hour. An attack of biliary colic usually last less than 6 hours.
In some cases, a gallstone permanently blocks the cystic duct, resulting in inflammation of the gallbladder (acute cholecystitis). In acute cholecystitis, the pain is severe, unrelenting and prolonged (usually longer than 6 hours). The pain is typically accompanied by a fever.
Occasionally, the stone may move out of the gallbladder and into the tube that carries bile to the intestine (known as the common bile duct). This can cause jaundice (yellow skin and eyes). You may also notice dark urine and light-colored stool.
Acute cholangitis (inflammation of the common bile and/or hepatic duct) occurs if bacteria enter the blocked tube. This leads to a high fever often with pain, vomiting, and extreme tiredness.
Gallstones can become lodged at the junction of the pancreas and common bile duct. This leads to inflammation of the pancreas (pancreatitis). Symptoms of gallbladder inflammation or infection that require a medical evaluation include:
- Yellowing of the skin and the whites of the eyes (jaundice)
A gallbladder tumor that blocks a bile duct can cause signs and symptoms similar to gallstones. An individual with gallbladder cancer may also have:
- Lumps on the right side of the belly
- Itchy skin
- Loss of appetite
- Weight loss
- Dark urine
- Light-colored or greasy stools
Laboratory tests may be done to help determine the type of gallbladder disease and detect complications. Individuals with uncomplicated gallbladder disease typically have normal lab tests results.
Examples of some laboratory tests that may be done when gallbladder disease is suspected include:
- Complete blood count (CBC)—evaluates blood cells; a high white blood cell count can indicate inflammation, infection, an abscess, or a ruptured gallbladder.
- CRP (C-reactive protein, the preferred test) or ESR (erythrocyte sedimentation rate)—elevated results indicate inflammation.
- Liver panel—if someone has gallstones that block bile ducts, results for bilirubin may be high due to bile backing up into the liver. Liver enzymes, especially alkaline phosphatase (ALP), may be elevated in severe cases of gallbladder inflammation.
- Lipase (the preferred test) or amylase—these pancreatic enzymes may be elevated if gallbladder disease has also caused pancreatitis.
Imaging tests are the primary tools for diagnosing gallbladder disease. These include:
- Ultrasound—imaging with ultrasound is the best way to detect gallstones. It can detect gallstones in the gallbladder with 95% accuracy. Ultrasound is less accurate at detecting gallstones in bile ducts, so those individuals may need further imaging. If follow-up imaging tests are unclear, a healthcare practitioner may order an endoscopic ultrasound to get a better view of gallbladder and bile duct structures. In this procedure, a very small ultrasound device is passed into the stomach via the mouth, then into the small intestine. An ultrasound can also detect signs of acute gallbladder inflammation like fluid around the gallbladder and a thickened gallbladder wall. People with gallstones may notice that their abdomen feels tender while receiving the ultrasound.
- Magnetic resonance imaging (MRI)—this non-invasive imaging technique is used to look for stones in the gallbladder.
- Computed tomography (CT)—this test can detect gallstones and also look for complications from gallbladder inflammation, such as pancreatitis or a ruptured gallbladder.
- Endoscopic retrograde cholangiopancreatography (ERCP)—this imaging test is used when the cause of gallbladder or bile duct inflammation is difficult to diagnose. An endoscope is threaded through the mouth and used to inject a radioactive substance into the biliary tract. This lets healthcare practitioners see obstructions in the bile ducts. An advantage of this test is that the endoscope used for testing can also be used for biopsies or treatment of bile ducts during the procedure.
To learn more about these imaging procedures, visit RadiologyInfo.org.
Lifestyle choices can reduce the risk of gallstones. These include:
- Eating regular meals: skipping meals or fasting can increase the risk of gallstones.
- Avoiding rapid weight loss: if weight loss is a goal, aim for losing 1 to 2 pounds per week. Rapid weight loss is a risk factor for gallstones.
- Eat a healthy diet: high fat, low fiber diets may increase the risk of gallstones.
Gallstone and gallbladder diseases only require treatment if they cause symptoms. Treatment will depend on how the disorder is affecting an individual and if they are at risk for ongoing gallbladder disease and accompanying pain.
Gallbladder removal is the most common treatment for gallstones that cause ongoing signs and symptoms, infection or other complications. While the gallbladder helps with digestion, it is not necessary for survival. (Learn more about gallbladder removal from the American College of Surgeons.)
If gallbladder removal surgery is too risky, gallstones may be dissolved with drugs taken orally. This process can take months and, in some cases, up to two years. This treatment is not always effective.
For more information on treatment, see the links in Related Content.
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