Gallbladder disease

Reviewed by Jessica Muñoz, Jessica Muñoz is a registered nurse and educator with 20 years of experience in critical care emergency nursing, specializing in patient care, education, and evidence-based practice. She holds multiple certifications and serves as a Patient Safety Coordinator.

Gallbladder disease refers to a group of conditions that affect the gallbladder, a small pear-shaped organ situated under the liver. The main function of the gallbladder is to store bile, which is produced by the liver, and then pass it through a duct to the small intestine for fat digestion.

The majority of gallbladder diseases are caused by inflammation, called cholecystitis, that occurs when gallstones block the duct leading to the small intestine. This blockage results in the accumulation of bile, which can lead to tissue necrosis or gangrene over time.

Gallstones affect up to 15% of the population, and around 20% of those affected experience symptoms or complications. Typically, gallbladder disease is strongly associated with the presence of gallstones.

Gallbladder diseases include

Gallstones (cholelithiasis)

While gallstones are the primary cause of gallbladder diseases, they often do not produce any symptoms. These stones are typically benign and are formed from surplus bile components, primarily cholesterol, which accumulate in the gallbladder. However, they can cause inflammation by obstructing the flow of bile through the bile duct.

Cholecystitis (inflammation)

The primary symptom of gallbladder disease is cholecystitis, which carries its own set of complications. Inflammation of the gallbladder can signal underlying issues such as infection, obstruction, or, in rare cases, cancer. Prolonged swelling of the gallbladder can result in tissue scarring, gangrene, and eventual rupture.

Biliary dyskinesia

Biliary dyskinesia, a functional disorder affecting the gallbladder, poses a significant health concern. It manifests as an impaired ability of the gallbladder to carry out its functions effectively, leading to the reflux of bile and subsequent chronic inflammation. This condition is often attributed to issues with nerve or muscle function.

Gangrene

Chronic cholecystitis can lead to the most severe outcome, which is gallbladder gangrene. When the gallbladder becomes chronically inflamed, it can result in tissue death. These dead tissues can rupture or detach at any time, posing a significant risk. If the gallbladder wall becomes perforated due to persistent swelling, it can lead to infection and peritonitis, which can put the entire abdominal cavity at risk. Therefore, it is crucial to take cholecystitis seriously and seek appropriate medical attention.

Gallbladder cancer

Gallbladder or bile duct cancer is a rare but serious condition that can pose a significant threat to health. Unfortunately, symptoms tend to appear only at an advanced stage, which makes it easy to miss them. It’s important to note that not all growths or tumors in the gallbladder are malignant. However, it is recommended to surgically remove larger tumors for optimal management of the condition.

Cholangiopathy

Cholangiopathy is a disorder of the bile ducts which starts with the swelling of the bile ducts and cholangitis. This swelling can lead to blockage, infection, or autoimmune conditions like primary biliary cholangitis. As time passes, it can cause the bile ducts to narrow and scar, leading to the return of bile to the gallbladder and liver.

Diagnosis

Healthcare providers may suggest the following tests to pinpoint the exact cause of the condition:

• Liver function test: This blood test aids in detecting blockages in the bile ducts.
• Pancreas function test: Another blood test to identify blockages in the pancreatic duct.
• Complete blood count: This test reveals elevated levels of white blood cells, indicating inflammation or infection.
• Abdominal ultrasound is a noninvasive imaging test that highlights blockages, swelling, or growths in the gallbladder or bile ducts.
• HIDA scan (cholescintigraphy scan): This imaging test assesses the gallbladder’s emptying function into the small intestine and bile flow through the bile ducts.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This test combines endoscopy with X-ray technology. It involves a lighted camera attached to a long tube inserted through the throat to view internal organs. Fluoroscopic X-rays help detect bile duct blockages, which can often be treated on the spot by inserting small instruments through the endoscope.
• Endoscopic Ultrasound (EUS): This is another endoscopic imaging test that merges endoscopy with ultrasound technology. It also employs a lighted camera attached to a long tube. During this procedure, a specialized endoscope with ultrasound technology is passed through the throat into the abdomen to visualize organs such as the liver, gallbladder, pancreas, and bile ducts. The doctor may recommend further tests or procedures to address the condition if any abnormalities are observed.

Having gallstones increases the likelihood of developing gallbladder disease. Common risk factors for gallbladder disease include:

• Obesity and overweight: Excessive weight can prompt the body to produce more cholesterol, especially in individuals with a body mass index (BMI) above the recommended level.
• High-cholesterol diet: Diets rich in cholesterol contribute to the formation of gallstones in the gallbladder, increasing the risk of gallbladder disease.
• Advanced age: Gallstones are more prevalent in individuals over the age of 60, as they have had more time for cholesterol-rich stones to accumulate in the gallbladder.
• Female gender: Women face a twofold higher risk of developing gallstones compared to men. During pregnancy, elevated estrogen levels can lead to increased cholesterol production and reduced gallbladder emptying.
• Family history: Gallbladder disease often exhibits familial patterns, with about a quarter of cases having a hereditary component. Research has identified approximately 12 genes associated with the condition.

Risk factors

• Individuals of Native American or Mexican American descent face a 30 to 70% increased risk of gallstones due to a combination of genetic predisposition and dietary factors.
• Diabetes doubles or triples the risk of gallstone formation, likely due to elevated levels of fatty acids.
• Crohn’s disease doubles the risk of gallstone development as it impairs the absorption of bile salts, which aid in breaking down cholesterol in the gallbladder.
• Liver cirrhosis, particularly in advanced stages, can impede bile flow from the liver to the gallbladder, leading to bile accumulation.
• Sickle cell disease causes an accumulation of bilirubin in the gallbladder, forming rare pigmented gallstones.
• Total parenteral nutrition, administered intravenously for medical reasons, can lead to bile accumulation in the gallbladder due to reduced digestive system activity.
• While effective in reducing blood cholesterol levels, cholesterol-lowering medications may contribute to gallstone formation by promoting cholesterol buildup in the gallbladder.

Treatment

• Pain Management: Severe episodes of biliary colic, also known as gallbladder attacks, may require prescription pain medication to alleviate symptoms. The appropriate medication is determined by the patient’s medical history and the severity of their symptoms.
• Antibiotics: In certain cases, antibiotics may be prescribed to treat specific infections, particularly as a preparatory measure before surgery.
• Endoscopic Intervention: For minor gallbladder disorders, endoscopic procedures may be employed as a treatment option prior to surgery. Tests such as ERCP or EUS can identify issues like tumors, blockages, or stones. Following these tests, the doctor may insert stents to widen bile ducts, remove gallstones, or obtain tissue samples for biopsy using specialized instruments attached to the endoscope.
• Surgery: The most effective and long-term solution for chronic gallbladder disease is gallbladder removal surgery, known as cholecystectomy. This procedure is relatively straightforward, and individuals can lead normal lives without a gallbladder. Many surgeries can be performed using minimally invasive laparoscopic techniques, involving only a few small incisions. However, more complex cases, such as severe infections or cancer, may necessitate open surgery.

Prevention

While certain risk factors for gallbladder disease, like age and sex, are beyond control, diet plays a pivotal role in gallstone development. According to research from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), incorporating healthy fats and fiber-rich foods into one’s diet can help prevent gallstones.

By including foods such as whole grains (like brown rice and whole wheat bread), fish, and olive oil in your diet, you are taking a positive step towards reducing the risk of gallstones. Conversely, refined grains (such as sugary cereals, white rice, bread, pasta, and sweets) pose higher risks for gallbladder disease.

Early diagnosis and treatment of gallbladder disorders can mitigate significant complications. It’s advisable to seek medical advice promptly upon experiencing any signs or symptoms of gallbladder disease.

Work cited

• Gallbladder Disease, 2022. My.Clevelandclinic.org. https://my.clevelandclinic.org/health/diseases/22976-gallbladder-disease
• Gallbladder Disease, 2024. Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/gallbladder-disease
• Gallbladder Disease, 2024. Healthline.com. https://www.healthline.com/health/gallbladder-disease