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The Pains and Problems of Gallbladder Disease

By: Gwen Reyes-Amurao, MD The Pains and Problems of Gallbladder Disease

The gallbladder is a small organ found beneath the liver, located on the right side of one’s midsection, directly below the ribs. Often described as pouch-like, the gallbladder mainly stores bile that is produced by the liver and helps the body digest fat in response to food or meal intake. After eating, the gallbladder contracts and stimulates bile to enter into the small intestine to help break down fats. Although bile stored in the gallbladder helps digest fat, a person may survive without this organ and simply experience diarrhea or fat malabsorption. Suffice to say, keeping the gallbladder healthy is still important for proper digestion and prevention of conditions that may affect functions associated with it.

Gallbladder Diseases

According to the School of Medicine of Johns Hopkins University, gallbladder illnesses may be in the form of inflammation, infection, stones, and blockage of the gallbladder and/or bile duct. In medical terms, they are more commonly known as cholecystitis, cholelithiasis (gallstones), gallbladder gangrene or abscess, chronic acalculous gallbladder disease, sclerosing cholangitis, or gallbladder cancer. 

Gallstones

Gallstones are formed when substances in the bile, such as cholesterol or substances from the blood known as bilirubin, form into hard particles, which may or may not block the passageways to the gallbladder and bile ducts. These stones vary in size, shape, and firmness. Certain factors may place people at risk for developing gallstones such as obesity, diabetes, certain medications, genetic predisposition, and having other medical conditions such as Crohn’s disease or liver illness. Unfortunately, females are also more likely to have gallstones than males.

Cholecystitis

Cholecystitis or inflammation of the gallbladder is the most common type of gallbladder disease and can be acute (sudden) or chronic (long-standing or prolonged). Acute cholecystitis is generally caused by gallstones but may also be caused by tumors and other underlying medical conditions.

Choledocholelithiasis

This condition occurs once stones become lodged in the passageway or bile duct, preventing bile from exiting the gallbladder, leading to distention and/or inflammation. In some cases though, inflammation of the gallbladder can occur without the presence of gallstones, which results in a condition known as acalculous gallbladder disease. Risk factors that can lead to this condition include severe physical trauma, history of heart or abdominal surgery, severe burns, and the presence of moderate to severe infection.

Biliary dyskinesia

According to the American Pediatric Surgical Association, this type of dyskinesia or abnormality of movement is a condition in which the gallbladder does not contract well, disabling the bile unable to drain out the gallbladder properly. After a meal, it typically contracts and releases bile into the small intestine to help in digestion of food. According to the Current Treatment Options of Gastroenterology, when this abnormality occurs, contraction of the gallbladder becomes irregular leading to improper digestion of food, resulting to complications such as indigestion and even recurrent episodes of pancreatitis.

Sclerosing cholangitis

The Mayo Clinic defines primary sclerosing cholangitis as the inflammation of the bile ducts which results in scarring, hardening, and narrowing of the ducts. Although progressing gradually, this condition can lead to a variety of complications such as repeated infections, liver failure, and sometimes even tumors of both the bile duct and the liver.

Cancer

Since gallbladder cancer is fairly uncommon, it is often not detected until the later stages of the disease. According to the American Cancer Society though, because of its rarity, symptoms often identified with gallbladder cancer would most likely be due to another medical condition and not malignancy.

Polyps

Gallbladder polyps are growths within the organ which are usually benign. Since a person can survive without a gallbladder, some specialists would recommend that it can be removed in the presence of polyps, especially those that are larger than a centimeter since these often have a higher risk of developing into malignancy.

Conditions of the gallbladder that are also commonly reported are gangrene and abscess formation. Gangrene results from inadequate blood flow to the gallbladder as a result of acute cholecystitis. A gallbladder abscess can also result from acute cholecystitis especially when this happens in the presence of gallstones, which blocks the bile duct completely, leading to pus formation. Diabetics are often at risk for developing both gangrene and abscess formation.

Signs and Symptoms of Gallbladder Disease

Gallbladder disease, no matter which type, will almost always present with intermittent pain known as biliary colic. A person suffering from such conditions typically experiences what they may describe as gripping or gnawing pain in the right upper part of the abdomen, specifically near the ribcage or below the ribs. At times, the pain may be so severe that it radiates to the upper back or behind the mediastinum or breast bone. Other associated symptoms may include:

  • Nausea or vomiting
  • Fever
  • Chills
  • Abdominal discomfort especially after meals
  • Diarrhea

In the presence of blockages resulting from stones lodging in the bile duct, symptoms may be similar to any type of gallbladder disease, with the person experiencing any or all of the following:

  • Jaundice or yellowish discoloration of the skin
  • Dark-colored urine
  • Acholic or pale stools

Although gallbladder malignancy will often present the same way as those symptoms mentioned above, accompanying characteristics may be present such as loss of appetite, unexplained weight loss, abdominal distention or swelling in the abdomen, recurrent or persistent fever, and sometimes skin itchiness due to buildup of substances within the skin layers that are not properly digested because of gallbladder dysfunction.

Diagnosing Gallbladder Disease

In diagnosing gallbladder disease, a complete medical history and a thorough abdominal exam are just as essential as diagnostic tests. On physical examination, a maneuver known as Murphy’s Sign will mostly likely be positive in the presence of gallbladder disease. This is elicited by firmly placing a hand at the area right below the right ribs, in the right upper part or abdominal quadrant. If the gallbladder is inflamed, the patient will experience severe pain on deep inhalation, which may lead them to catch or hold their breath while inhaling.

Although abdominal X-rays can sometimes reveal stones especially if they contain calcium, an ultrasound of the abdomen is often more sensitive and more specific in detecting the presence of gallbladder disease. It can also detect the presence of gallstones, polyps or masses, as well as detect liver involvement in the presence of gallbladder conditions.

Management of Gallbladder Disease

Once the type of gallbladder disease is determined, the type of management or treatment can then be decided since it may vary depending on the gallbladder condition present.

Diet and lifestyle modification

This is often advised in the presence of gallstone formation especially in those with weight issues. The same is advised for those with diabetes. Increasing physical activity, smoking cessation, and limiting alcohol intake all collectively contribute to decreased incidence of gallstone formation.

Medications

Because pain is a primary symptom of gallbladder disease, pain medications may be prescribed by a specialist although care must be given since some pain medications may affect liver function. Anti-inflammatory medications may be recommended intravenously especially in severe cases. In the presence of dyskinesia or an abnormality in the movement or contractility of the gallbladder, the National Institute of Health has studied the role of domperidone in producing a modest contraction in the gallbladder and in improving gallbladder emptying. This drug is also often indicated in those suffering from nausea or vomiting associated with decreased motility in the gastrointestinal tract, symptoms of which may be found in gallbladder disease.

When it comes to addressing gallstones, treatment may not be recommended in the absence of signs or symptoms. In certain cases though, especially in severe pain or blockage, the following may be advised:

  • Surgical removal of the gallbladder or cholecystectomy – Since an individual can live and function normally without a gallbladder, this procedure is often performed in almost all types of gallbladder disease since doing so can help prevent complications arising from any of the conditions previously discussed.
  • Medications to help dissolve gallstones such as ursodeoxycholic acid – Oral medications are often given to those with gallstones who are not able to undergo surgery. Recent studies showed the use of domperidone in potentiating gallbladder emptying, which proved to be helpful especially in the removal of stone particles once they had undergone dissolution with the use of ursodeoxycholic acid.

Preventing Gallbladder Disease

According to the National Institute of Diabetes and Digestive and Kidney Diseases, diet plays a major role in gallbladder disease. Foods high in fiber have been studied to help prevent gallstones, while refined grains such as white rice and sugary cereals and sweets were associated with a higher risk of gallbladder disease.

In general, food that helps the digestion process will support the gallbladder itself. Fruits and vegetables, lean proteins, high fiber, and healthful fats such as omega-3-rich food can help improve and maintain a healthy gallbladder, not to mention a healthy mind and body as well.

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