What You Need To Know About Gallbladder Disease | Gastroenterology

Gallbladder Disease

Overview of gallbladder disease

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.

What are the types of gallbladder disease?

There are many different types of gallbladder disease.

Gallstones

Substances in the bile (such as cholesterol, bile salts, and calcium) or substances in the blood (such as bilirubin) form hard cells that block passage to the gallbladder and bile ducts.

Gallstones can also form when the gallbladder is not empty or insufficient. Many factors contribute to the risk of gallstones.

In addition to:

  • Overweight
  • Diabetes
  • Being 60 years age or older
  • Taking medications that contain estrogens
  • Family history of gallstones.
  • Crohn’s disease and other conditions affect how nutrients are absorbed.
  • You have cirrhosis or other liver diseases.

Cholecystitis

Cholecystitis is the most common type of gallbladder disease. It presents itself as either an acute or chronic inflammation of the gallbladder.

Acute cholecystitis

Acute cholecystitis is usually caused by gallstones. But it can also be the result of tumours or other diseases.

It can be a pain in the upper right quadrant or the upper middle abdomen. The pain occurs immediately after a meal and radiates to the right shoulder from sharp pains to dull aches. Acute cholecystitis can also be caused by:

  • Fever
  • Nausea
  • Vomiting
  • Jaundice

Chronic cholecystitis

After several attacks of acute cholecystitis, the gallbladder shrinks and loses the ability to store and release bile. Abdominal pain, nausea, and vomiting may occur. Surgery is often the necessary treatment for chronic cholecystitis.

Choledocholithiasis

The gallbladder is located in the neck of the gallbladder or the bile ducts. When the gallbladder is plugged in this way, the bile does not come out. This can cause the gallbladder to become inflamed or enlarged.

Clogged bile ducts prevent bile from travelling from the liver to the intestines.

Choledocholithiasis can cause:

  • Extreme pain in the middle of your upper abdomen
  • Fever
  • Chills
  • Nausea
  • Vomiting
  • Jaundice

Achilles tendonitis

Inflammation of the gallbladder without gallstones Acalculous disease of the gallbladder. Having a major chronic illness or serious medical condition can trigger an episode.

Some risk factors for the disease are:

  • Serious physical injury
  • Heart surgery
  • Abdominal surgery
  • Severe burns
  • Autoimmune conditions like lupus
  • Circulatory infections
  • Intravenous (IV) intake of nutrients
  • Major bacterial or viral diseases

Biliary dyskinesia

Biliary dyskinesia occurs when the gallbladder works less than normal. This condition may be related to ongoing inflammation of the gallbladder.

Abdominal pain after eating, nausea, bloating, and indigestion. Eating a fatty meal can cause symptoms. Gallstones in the gallbladder are generally absent with dyskinesia of the gallbladder.

Your doctor will need to use a test called a HIDA scan to diagnose this condition. This test measures the function of the gallbladder. If the gallbladder can release only 35 to 40 per cent or less of its contents, gallbladder dyskinesia is usually diagnosed.

Sclerosing cholangitis

Inflammation and damage to the bile duct system can lead to scarring. This condition is called sclerosing cholangitis. But, the exact cause of this disease is unknown. Almost half of the people with this condition have no symptoms.

If symptoms do occur, they include:

  • Fever
  • Jaundice
  • Itching
  • Upper abdominal discomfort

About 60 to 80 per cent of people with this condition also have ulcerative colitis. Having this condition also increases your risk of liver cancer. Currently, the only known cure is liver transplantation.

Medications that suppress the immune system and medications that help break down thick bile can help control symptoms.

Gallbladder cancer

Gallbladder cancer is a very rare disease. There are different types of gallbladder cancers. They are difficult to treat because they are often not diagnosed until the disease progresses. Gallstones are a common risk factor for gallbladder cancer.

Gallbladder cancer spreads from the inner walls of the gallbladder to the outer layers and then to the liver, lymph nodes, and other organs. The symptoms of gallbladder cancer may be similar to those of acute cholecystitis, but the symptoms may not be the same.

Gallbladder polyps

Gallbladder polyps are lesions or growths that occur in the gallbladder. They are usually benign and have no symptoms. However, removing the gallbladder is often recommended for polyps larger than 1 cm. They are more likely to develop cancer.

Gangrene of the gallbladder

Gangrene occurs when the gallbladder develops insufficient blood flow. It is one of the most serious complications of acute cholecystitis. The factors that increase the risk of this problem are:

  • Male and over 45 years old
  • Diabetes

Symptoms of gallbladder gangrene include:

  • Dull pain in the gallbladder area
  • Fever
  • Nausea or vomiting
  • Disorientation
  • Low blood pressure

Lack of gallbladder

The result of the gallbladder when the gallbladder is inflamed with pus. This is the accumulation of white blood cells, dead tissue, and bacteria. There is pain on the right side of the abdomen along with fever and chills.

This condition occurs during acute cholecystitis when the gallbladder completely blocks the gallbladder, allowing the gallbladder to fill with pus. It is more common in people with diabetes and heart disease.

Diagnosis methods

To diagnose gallbladder disease, your doctor will ask about your medical history and perform an abdominal exam. This includes checking for pain in the abdomen. One or more of the following tests and procedures may be used:

Detailed medical history

The list of symptoms you are experiencing and a personal or family history of gallbladder disease is important. A general health assessment may also be done to find out if there are signs of chronic gallbladder disease.

Chest and abdomen x-ray

Symptomatic cholecystitis sometimes shows stones on abdominal radiographs if there is calcium in the stones. A chest x-ray shows pleurisy or pneumonia.

However, X-rays are not the best test to diagnose gallbladder disease. They are often used to rule out gallstones, gallstones, or other possible causes of pain not related to the liver.

Ultrasound

Ultrasound uses sound waves to create images inside your body. This test is one of the main methods your doctor uses to diagnose gallbladder disease. Ultrasound can evaluate the gallbladder for the presence of a gallbladder, thickened walls, polyps, or masses. It can also detect any problems in your liver.

HIDA scan

A HIDA scan examines the duct system of the gallbladder and liver. It is often used when a person has gallbladder symptoms, but ultrasound has not shown the cause of the symptoms. The HIDA scan can also be used for a more comprehensive evaluation of the bile duct system.

This test can evaluate the function of the gallbladder using a harmless radioactive material. This substance is injected into the vein and is seen as it moves through the gallbladder. The gallbladder can also inject another chemical that causes bile to be released.

This scan shows how the gallbladder moves bile through the bile duct system. It can also measure the rate of bile outflow from the gallbladder. This is called the ejection fraction. The normal ejection fraction to the gallbladder is considered to be between 35 and 65 per cent.

Other tests

Other imaging tests, such as CT scans and MRIs, may also be used. Blood tests are also done to check the number of white blood cells and abnormal liver function.

Endoscopic retrograde cholangiopancreatography (ERCP) is a more harmful but useful test. The flexible chamber is inserted into the mouth and the small intestine beyond the stomach. A contrast die is injected to show the bile duct system with a special x-ray.

ERCP is a particularly useful test if an obstruction caused by gallstones is suspected. Often, any gallbladder that interferes with this process is removed.

Treatment options

Changes in lifestyle

Because certain health conditions increase the risk of gallbladder formation, lifestyle changes can help control gallbladder disease in asymptomatic people. Being overweight and having diabetes increases the risk of gallstones. Losing weight and better managing diabetes can help lower your risk.

However, rapid weight loss also stimulates the formation of the gallbladder. Get doctor suggestions about safe ways to lose weight.

Increased physical activity reduces the amount of fat in the blood, high triglycerides, and decreases the formation of the gallbladder. Quitting smoking and limiting alcohol consumption are often recommended.

Medical treatment

The first episode of gallbladder inflammation is often treated with pain relievers. Because pain can often severe, prescription medications are needed. Your doctor may prescribe codeine or hydrocodone medications. The intravenous prescription can prescribe strong anti-inflammatory or pain reliever medications like morphine.

Over-the-counter medications such as ibuprofen and naproxen (Olive) are not used often due to the increased risk of nausea and vomiting. If you are dehydrated, anti-inflammatory medications can also cause serious kidney problems.

Most people find it difficult to control pain at home and its accompanying symptoms. Talk to your doctor to discuss the best treatment for you.

Ongoing research is examining the use of an active drug called ezetimibe and its role in reducing cholesterol gallstones. This medicine changes the way the body absorbs cholesterol from the intestine.

Surgery

Surgery to remove the gallbladder is recommended if you experience multiple bouts of inflammation. Gallbladder surgery remains the most effective method for treating active gallbladder disease.

The surgery can be done by opening your abdomen with an incision or laparoscopically. This involves drilling several holes through the abdominal wall and inserting the camera. Laparoscopic surgery allows for a faster recovery. This method is preferred for people who do not have complications from major gallbladder disease.

Complications of gallbladder disease

The gallbladder forms an abnormal passageway or fistula between the gallbladder and the intestine by processing bile from the liver. Most of the time it is a problem of chronic inflammation associated with gallstones.

Other problems include:

  • Bowel obstruction
  • Inflammation and scars.
  • Perforation (hole in the gallbladder).
  • Bacterial contamination of the abdomen called peritonitis.
  • Malignant mutation (transformed cells turn into cancerous tumours).

Can gallbladder disease be prevented?

Certain risk factors for gallbladder disease, such as sex and age, can’t be changed. However, your diet may play a role in developing gallstones. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), foods high in fibre and healthy fats may help prevent gallstones.

Refined grains (found in sugary cereals and white rice, bread, and pasta) and sugary sweets are associated with a higher risk of gallbladder disease. Whole grains like brown rice and whole wheat bread and fats from fish and olive oil are all recommended.

The earlier gallbladder problems are recognized and treated, the less likely significant complications will occur. It’s important to talk to your doctor if you’re experiencing any signs or symptoms of gallbladder disease.

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