What To Know about Gallbladder Disease

Gallbladder disease refers to several conditions that affect the health and function of the gallbladder—a small, pear-shaped organ that plays an important role in the digestive system. The gallbladder stores bile (a digestive fluid the liver produces) and delivers it to the small intestine, where it helps digest fat. 

Gallbladder disease can develop when inflammation, infection, or blockages affect the gallbladder or bile ducts—the tubes that carry bile to and from the gallbladder. Symptoms of gallbladder disease depend on the exact condition you have, but common signs include abdominal pain, nausea, vomiting, or jaundice (yellowing of the skin).

A high-fat diet, obesity, older age, certain medications, diabetes, and rapid weight loss can increase the risk of gallbladder disease, which affects over 20 million adults in the United States. Treatment options include lifestyle changes, medication and specialist procedures, and surgery. 

Types of Gallbladder Disease 

There are several gallbladder diseases, ranging in severity from mild to serious. These include:

• Gallstones (cholelithiasis): Gallstones are hard, pebble-like deposits that form in the gallbladder. They can be as small as a grain of sand or as large as a golf ball. Most gallstones are "silent," meaning they cause no symptoms. If a gallstone blocks bile flow in the gallbladder or bile ducts, it can cause a gallbladder attack (biliary colic).
• Cholecystitis: This is inflammation of the gallbladder, causing swelling and gallbladder irritation. It usually develops when a gallstone lodges in a bile duct, blocking bile flow. Cholecystitis can be acute (sudden and short-term) or chronic (recurring and long-term).
• Biliary dyskinesia: This occurs when the gallbladder has trouble emptying bile into the small intestine. Usually, when food enters your stomach, smooth muscle tissues in the gallbladder contract to push bile out of your gallbladder and into the small intestine, helping digest fat. With biliary dyskinesia, these contractions are inefficient, and bile builds up in the gallbladder, leading to upper abdominal pain and digestive problems.
• Gallbladder polyps: These are growths that form on the gallbladder's inner lining (mucosa) and stick out into the hollow space inside the organ (lumen) where bile is stored. Most polyps are benign and don't cause symptoms, but larger polyps may increase the risk of gallbladder cancer.
• Gallbladder cancer: This is a rare form of cancer that starts in the gallbladder tissues when abnormal cells grow uncontrollably. Gallbladder cancer rarely causes symptoms in its early stages and is hard to detect and diagnose, as it often causes symptoms similar to other gallbladder diseases. 

Gallbladder Disease Symptoms 

The symptoms of gallbladder disease can vary depending on the type and severity of the condition. 

Gallstones Symptoms

Gallstones do not always cause symptoms, but if a gallstone blocks bile flow out of the gallbladder or bile duct, a gallbladder attack can occur, causing symptoms such as:

• Right upper quadrant pain that radiates to the right shoulder 
• Pain lasting 30 minutes to hours
• Excessive sweating
• Nausea and vomiting

Gallbladder attacks are most likely to develop after eating a heavy meal and typically occur in the evening or night.

Cholecystitis Symptoms

Cholecystitis, or gallbladder inflammation, usually causes sharp, cramping, or dull pain in the upper right abdomen that spreads to the back or below the right shoulder blade. The pain typically lasts for 30 minutes or more. Other symptoms include: 

• Fever
• Clay-colored stools
• Nausea and vomiting
• Jaundice

Biliary Dyskinesia Symptoms

Biliary dyskinesia occurs when the gallbladder doesn't empty properly, leading to recurrent pain and symptoms such as:

• Moderate to excruciating upper right-side abdominal pain that gradually worsens
• Nausea and vomiting 
• Excessive sweating
• Pain that develops or worsens after eating a meal 

Gallbladder Polyp Symptoms

Most gallbladder polyps (growths) are asymptomatic, and many people do not realize they have them until they have an abdominal imaging test (e.g., ultrasound). However, larger polyps may impair bile flow and cause symptoms similar to gallstones, including: 

• Upper right abdominal pain
• Nausea 
• Bloating

Gallbladder Cancer Symptoms

Gallbladder cancer often causes no symptoms in its early stages. As the tumor grows, symptoms may include: 

• Persistent upper right abdominal pain 
• Bloating
• Lumps in the abdomen 
• Nausea and vomiting
• Fever
• Jaundice
• Appetite changes
• Unintended weight loss
• Greasy or light-colored stools 

What Causes Gallbladder Concerns?

Gallbladder disease develops when inflammation or irritation affects the gallbladder's ability to store and release bile.

The most common cause of gallbladder disease is gallstones, which develop when there is an imbalance of bile and cholesterol (fat) or bilirubin (a byproduct of the normal breakdown of red blood cells). These stones can block the biliary ducts, which carry bile to and from the gallbladder, leading to inflammation (cholecystitis).

Chronic or recurrent gallstones or inflammation can increase the risk of more serious forms of gallbladder disease, such as chronic cholecystitis or gallbladder cancer.

Risk Factors

While anyone can develop gallbladder disease, certain factors can increase your risk, such as: 

• Being assigned female at birth or being over the age of 40
• Having Hispanic or Indigenous heritage or a family history of gallbladder disease
• Taking estrogen-containing medications such as birth control or hormone replacement therapy
• Living with underlying health conditions such as cirrhosis, sickle cell anemia, inflammatory bowel disease, high cholesterol, diabetes, and obesity
• Eating a high-calorie, low-fiber diet
• Losing weight rapidly

The Diagnostic Process

If you're experiencing symptoms of gallbladder disease, it's important to seek care early. Getting a diagnosis and starting treatment can prevent complications from occurring.

When you see your provider, you can expect them to ask about your medical history, symptoms, and lifestyle habits. They'll also perform a physical exam and order certain diagnostic tests, which may include:

• Blood tests: Check for markers of infection or inflammation in the gallbladder, bile ducts, or liver 
• Abdominal ultrasound: Uses sound waves to create pictures of your abdominal organs, including the gallbladder, to identify gallstones
• Computed tomography (CT) scan: Involves using X-rays and computer technology to create detailed images of your gallbladder, bile ducts, and pancreas to identify gallstones or blockages in the gallbladder or bile ducts
• Magnetic resonance imaging (MRI): Creates images of your internal organs and soft tissues, helping identify gallstones, blockages in the bile ducts, and other abnormalities (e.g., tumors)
• Cholescintigraphy (HIDA scan): Utilizes a safe radioactive material to create pictures of the biliary tract by injecting a small amount of radioactive material into a vein and using a special camera to track its movement through the gallbladder and bile ducts to diagnose gallbladder dysfunction or blockages in the bile ducts
• Endoscopic retrograde cholangiopancreatography (ERCP): Combines endoscopy and X-rays to examine the bile and pancreatic ducts and identify blockages or other abnormalities
• Biopsy: Takes a small piece of tissue from the gallbladder or bile ducts during an ERCP and sends it to the lab for testing

Gallbladder Disease Treatment 

If you receive a diagnosis of gallbladder disease, receiving treatment for your condition is essential. Your exact treatment plan will depend on your condition, the severity of your symptoms, and your overall health, but may include a combination of surgical and nonsurgical treatments.

Surgery 

Gallbladder surgery is a highly effective treatment that may be necessary for gallstones or severe gallbladder disease. Surgery can cure many types of gallbladder disease and help prevent future gallbladder attacks. Surgical options include: 

• Laparoscopic cholecystectomy: Makes small incisions (cuts) in your abdomen to remove the gallbladder
• Open cholecystectomy: Cuts open the upper right abdomen to access and remove the gallbladder in cases of an extremely infected or enlarged gallbladder or a large gallstone
• Percutaneous cholecystostomy: Involves placing catheters (tubes) into the gallbladder to drain its contents, which may be necessary for people who are too fragile or sick to undergo surgery

Fortunately, you don't need your gallbladder to live a healthy and full life. If gallbladder removal is necessary, the liver continues to produce bile and releases it directly into the small intestine.

After gallbladder removal, some people may experience mild digestive changes, such as difficulty digesting fatty foods, nausea, diarrhea, and indigestion.

Nonsurgical Treatments 

Medications or specialist procedures may also help treat some types of gallbladder disease. These include: 

• ​​Endoscopic retrograde cholangiopancreatography (ERCP): Healthcare providers sometimes use ERCP to remove a gallstone stuck in a bile duct
• Oral dissolution therapy: Medications like Actigall (ursodiol) and Chenix (chenodiol) contain bile acids that help break down small cholesterol gallstones
• Shock wave lithotripsy: This procedure uses shock waves to break gallstones into smaller pieces
• Antibiotics: These medications can help treat or prevent infection in people with cholecystitis 

Is Prevention Possible?

Healthy lifestyle habits are the best way to protect your gallbladder health and prevent gallbladder disease. These include:

• Managing obesity and maintaining a body weight that's right for you
• Eating a diet rich in fiber and healthy fats, while limiting sugar and saturated fats
• Getting regular physical activity to regulate bile flow and reduce cholesterol levels in the bile

Complications 

Getting treatment for gallbladder symptoms is important. Untreated gallbladder disease can lead to serious complications, such as:

• Gallstone pancreatitis: If gallstones block the pancreatic duct, the pancreas can become inflamed, causing sharp, severe squeezing pain, nausea, and vomiting. 
• Gallbladder perforation: If cholecystitis (gallbladder inflammation) is left untreated, a tear in the gallbladder wall can occur, leaking gallbladder contents into the abdomen. 
• Organ damage: Untreated gallstones can cause permanent damage to the gallbladder, liver, or bile ducts. 

A Quick Review

Gallbladder disease refers to several conditions affecting the gallbladder, including gallstones, inflammation (cholecystitis), and gallbladder cancer, that cause symptoms like abdominal pain, nausea and vomiting, or jaundice.

Imaging scans and lab tests can diagnose gallbladder disease. If you receive a gallbladder disease diagnosis, treatments like medications, lifestyle changes, and surgery can manage most conditions and promote overall gallbladder health.