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About Gallbladder Disease
The gallbladder is a small sac located under the liver which stores and concentrates bile, which is produced in the liver. The gallbladder releases bile, which helps digest fat, into the upper small intestine after eating - especially fats.
Gallbladder disease is one of the most common and costly of all digestive diseases because treatment generally requires surgery and hospitalization. About one million Americans are diagnosed with gallbladder disease each year, and in total, about 20 million Americans are living with the disease - about 6.3 million men and 14.2 million women.
Gallbladder Disease Has Two Major Conditions:
Cholelithiasis is the presence of gallstones in the gallbladder
Cholecystitis is inflammation of the gallbladder The two major conditions that comprise gallbladder disease are gallstones and cholecystitis, which is an inflammation of the gallbladder wall and nearby abdominal lining. Only about one third of patients with gallstones will experience any symptoms. Individuals may have one or many gallstones. Gallstones often cause cholecystitis but can also travel elsewhere to cause additional problems.
Symptoms of Gallbladder Disease
An attack may last a few days, and may include:
- intense, sudden pain in the upper right side of the abdomen
- indigestion or pain after meals that lasts a few hours
- intolerance of fatty foods
- pain upon taking deep breaths that moves to right shoulder blade
- nausea and vomiting
- low fever
- jaundice (yellowing of the skin and eyes)
- abdominal bloating
- loose, light-colored stool
- rigid abdominal muscles on the right side
Causes of Gallbladder Disease
Gallstones form when bile, stored in the gallbladder, hardens, becoming stone-like. A slowing of gallbladder emptying and an excessive amount of cholesterol, bilirubin (bile pigment), or bile salts in the bloodstream may result in gallstones. There are two types of gallstones: cholesterol stones, which comprise about 80% of all gallstones, and pigment stones.
Gallstones are a risk factor for gallbladder cancer and cholangiocarcinoma (bile duct cancer), which are rare but are increasing in frequency. This increase may be due to a rise in obesity rates, a risk factor for gallstones. If a gallstone obstructs a bile duct, it can lead to a life-threatening infection of the bile ducts, liver, or pancreas.
Cholecystitis or gallbladder inflammation is usually caused by a gallstone located in the duct that connects the gallbladder to the hepatic (liver) duct, which is called the cystic duct. It may come on suddenly or develop slowly over a long period of time.
Other causes of cholecystitis may be:
- Decreased blood supply to the gallbladder caused by diabetes
- A bacterial infection in the bile duct, which carries bile from the liver and gallbladder into the duodenum region of the small intestine
- A tumor of the pancreas or liver
- Gallbladder "sludge" – thick material that is not absorbed by bile in the gallbladder and which is mostly seen in pregnant women or those who have had a rapid weight loss
Risk Factors for Gallbladder Disease
- Heredity: Gallstones tend to run in families.
- Gender: Women between ages 20 and 60 have a three times higher risk than men for gallstones due to the effects of estrogen, which causes more cholesterol to be excreted in bile.
- Hormone replacement therapy and birth control pills, which both contain estrogen, have similar effects.
- Age: Adults over age 60 have a greater chance of developing gallstones.
- Ethnicity: American Indians and Mexican Americans have the highest incidence of gallstones in the US.
- Being overweight or obese: Both increases cholesterol levels in bile and how frequently the pancreas empties bile.
- Rapid weight-loss: Losing three or more pounds per week changes bile chemistry, causing the liver to secrete more cholesterol into bile, causing gallstones to form.
- Use of cholesterol-reducing drugs: These drugs increase the amount of cholesterol secreted into bile.
- Cirrhosis, bililary tract infections, and sickle cell anemia all increase the risk of pigment stones.
- Cystic fibrosis
Diagnosis of Gallbladder Disease
Our gastrointestinal team will perform a number of tests to determine if you have gallstones or gallbladder inflammation, including an endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT or CAT) scan, cholecystography, ultrasound, and blood tests.
The ERCP procedure, which is state-of-the art, combines endoscopy and x-ray. With ERCP, doctors use an endoscope – a thin, flexible tube equipped with a light and camera – which he or she inserts into the sedated patient's throat, through the esophagus, stomach and duodenum, and into the gallbladder. A small tube is then threaded through the endoscope into which a dye is injected, which will enable x-rays to visualize the gallbladder and its ducts. This provides a good image of the structure of the gallbladder and any abnormalities.
Blood tests help determine if an infection, jaundice, pancreatitis, or obstruction is present.
Doctors may also use several non-invasive procedures to visualize the gallbladder and gallstones:
- Cholecystography, which consists of a number of x-rays taken of the gallbladder after the patient drinks a special contrast dye, and ultrasound, which uses sound waves to visualize a patient's abdominal organs and blood flow to them.
- CT scan uses specialized x-rays and computer technology to create cross-sectional views of the body's organs and bone structure.
Treatment for Gallbladder Disease
Gallstones and gallbladder inflammation when they cause pain may be treated in a number of ways, depending on your age, overall health, and the extent of the problem. Your doctor will discuss which method makes the most sense for you.
Treatments for Gallstones:
- Cholecystectomy – a surgical procedure where surgeons remove the gallbladder and restructure the biliary system so that bile flows directly from the liver into the small intestine. This procedure is usually performed laparoscopically, lowering the risk for patients and shortening their recovery time, compared with traditional, open surgery.
- Oral drug therapy – Drugs produced from bile acid may dissolve stones.
- Extracorporeal shockwave lithotripsy – A procedure that uses shock waves to break up stones into smaller pieces so they can pass through the bile ducts.
Treatments for Cholecystitis (Inflammation of the Gallbladder)
- Treatment for acute cholecystitis is usually done in the hospital to reduce gallbladder stimulation and irritation. Intravenous fluids and antibiotics are given to reduce inflammation and fight any infection present, along with other medication given to reduce pain.
- Surgery – Usually the gallbladder is removed.
- Oral drug therapy – Drugs may be given to dissolve gallstones.
- Low fat diet will be prescribed.