The term gallbladder disease is used for several types of conditions that can affect your gallbladder.
The gallbladder is a small pear-shaped sac located underneath your liver. Your gallbladder’s main function is to store the bile produced by your liver and pass it along through a duct that empties into the small intestine. Bile helps you digest fats in your small intestine.
Inflammation causes the majority of gallbladder diseases due to irritation of the gallbladder walls, which is known as cholecystitis. This inflammation is often due to gallstones blocking the ducts leading to the small intestine and causing bile to build up. It may eventually lead to necrosis (tissue destruction) or gangrene.
Types of gallbladder disease
There are many different types of gallbladder disease.
Gallstones develop when substances in the bile (such as cholesterol, bile salts, and calcium) or substances from the blood (like bilirubin) form hard particles that block the passageways to the gallbladder and bile ducts.
Gallstones also tend to form when the gallbladder doesn’t empty completely or often enough. They can be as small as a grain of sand or as large as a golf ball.
Numerous factors contribute to your risk of gallstones. These include:
- being overweight or obese
- having diabetes
- being age 60 or older
- taking medications that contain estrogen
- having a family history of gallstones
- being female
- having Crohn’s disease and other conditions that affect how nutrients are absorbed
- having cirrhosis or other liver diseases
Cholecystitis is the most common type of gallbladder disease. It presents itself as either an acute or chronic inflammation of the gallbladder.
Acute cholecystitis is generally caused by gallstones. But it may also be the result of tumors or various other illnesses.
It may present with pain in the upper right side or upper middle part of the abdomen. The pain tends to occur right after a meal and ranges from sharp pangs to dull aches that can radiate to your right shoulder. Acute cholecystitis can also cause:
After several attacks of acute cholecystitis, the gallbladder can shrink and lose its ability to store and release bile. Abdominal pain, nausea, and vomiting may occur. Surgery is often the needed treatment for chronic cholecystitis.
Gallstones may become lodged in the neck of the gallbladder or in the bile ducts. When the gallbladder is plugged in this way, bile can’t exit. This may lead to the gallbladder becoming inflamed or distended.
The plugged bile ducts will further prevent bile from travelling from the liver to the intestines. Choledocholithiasis can cause:
- extreme pain in the middle of your upper abdomen
- pale- or clay-coloured stools
Acalculous gallbladder disease
Acalculous gallbladder disease is inflammation of the gallbladder that occurs without the presence of gallstones. Having a significant chronic illness or serious medical condition has been shown to trigger an episode.
Symptoms are similar to acute cholecystitis with gallstones. Some risk factors for the condition include:
- severe physical trauma
- heart surgery
- abdominal surgery
- severe burns
- autoimmune conditions like lupus
- bloodstream infections
- receiving nutrition intravenously (IV)
- significant bacterial or viral illnesses
Biliary dyskinesia occurs when the gallbladder has a lower-than-normal function. This condition may be related to ongoing gallbladder inflammation.
Symptoms can include upper abdominal pain after eating, nausea, bloating, and indigestion. Eating a fatty meal may trigger symptoms. There are usually no gallstones in the gallbladder with biliary dyskinesia.
Your doctor may need to use a test called a HIDA scan to help diagnose this condition. This test measures gallbladder function. If the gallbladder can only release 35 to 40 percent of its contents or less, then biliary dyskinesia is usually diagnosed.
Ongoing inflammation and damage to the bile duct system can lead to scarring. This condition is referred to as sclerosing cholangitis. However, it’s unknown what exactly causes this disease.
Nearly half the people with this condition don’t have symptoms. If symptoms do occur, they can include:
- upper abdominal discomfort.
Approximately 60 to 80 percent of people with this condition also have ulcerative colitis. Having this condition does increase the risk of liver cancer as well. Currently, the only known cure is a liver transplant.
Medications that suppress the immune system and those that help break down thickened bile can help manage symptoms.
Cancer of the gallbladder is a relatively rare disease. There are different types of gallbladder cancers. They can be difficult to treat because they’re not often diagnosed until late in the disease’s progression. Gallstones are a common risk factor for gallbladder cancer.
Gallbladder cancer can spread from the inner walls of the gallbladder to the outer layers and then on to the liver, lymph nodes, and other organs. The symptoms of gallbladder cancer may be similar to those of acute cholecystitis, but there may also be no symptoms at all.
Gallbladder polyps are lesions or growths that occur within the gallbladder. They’re usually benign and have no symptoms. However, it’s often recommended to have the gallbladder removed for polyps larger than 1 centimetre. They have a greater chance of being cancerous.
Gangrene of the gallbladder
Gangrene can occur when the gallbladder develops inadequate blood flow. This is one of the most serious complications of acute cholecystitis. Factors that increase the risk of this complication include:
- being male and over 45 years old
- having diabetes
- The symptoms of gallbladder gangrene can include:
- dull pain in the gallbladder region
- nausea or vomiting
- low blood pressure
Abscess of the gallbladder
Abscess of the gallbladder results when the gallbladder becomes inflamed with pus. Pus is the accumulation of white blood cells, dead tissue, and bacteria. Symptoms may include upper right-sided pain in the abdomen along with fever and shaking chills.
This condition can occur during acute cholecystitis when a gallstone blocks the gallbladder completely, allowing the gallbladder to fill with pus. It’s more common in people with diabetes and heart disease.
Gallbladder Test & diagnosis
Gallbladder problems are diagnosed through various tests. These may include:
- Liver tests (LFT), which are blood tests that can show evidence of gallbladder disease.
- A check of the blood’s amylase or lipase levels to look for inflammation of the pancreas. Amylase and lipase are enzymes (digestive chemicals) produced in the pancreas.
- Complete blood count (CBC), which looks at levels of different types of blood cells such as white blood cells. A high white blood cell count may indicate infection.
- The use of ultrasound testing which uses sound waves to image and makes a picture of the intra-abdominal organs including the gallbladder.
- An abdominal X-ray, which may show evidence of gallbladder disease, such as gallstones.
- A computed tomography (CT) scan constructs a detailed X-ray image of the abdominal organs.
- A HIDA scan. In this test, a radioactive material called hydroxy iminodiacetic acid (HIDA) is injected into the patient. The radioactive material is taken up by the gallbladder to measure gallbladder emptying function. This test also is referred to as cholescintigraphy.
- Magnetic resonance cholangiopancreatography (MRCP), which uses magnetic resonance imaging (MRI) to produce detailed pictures.
- Endoscopic retrograde cholangiopancreatography (ERCP), a procedure in which a tube is placed down the patient’s throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder, liver, and pancreas can be seen on X-ray.
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Long term complications of gallbladder disease
The gallbladder may form an abnormal passageway, or fistula, between the gallbladder and the intestine to help process the liver’s bile. This is most often a complication of chronic inflammation related to gallstones.
Other complications can include:
- obstruction of the intestine
- inflammation and scarring
- perforation (a hole in the gallbladder)
- bacterial contamination of the abdomen, known as peritonitis
- malignant transformation (the change cells undergo to become a cancerous tumour)
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