Gallbladder Disorders

The gallbladder is a pear-shaped sac found just below the liver that is the “holding area” for bile. Bile is produced by the liver to help digest foods. The gallbladder releases the bile into the small intestine to help break down food, particularly fatty foods.

Usually, the gallbladder is not the subject of a health concern. However, if something slows the flow of bile or blocks it completely, then problems can occur. 

The presence of other (co-morbid) conditions may also cause gallbladder concerns, including:

• Obesity
• Childbirth
• Gender-related (female) conditions
• Consumption of fatty foods

Common gallbladder disorders include:

• Biliary colic. A term for severe episodes of pain caused by gallstone blockage of the cystic duct. The blockage causes the gallbladder to contract vigorously, causing spasmodic (or sometimes constant) severe pain. Episodes usually last only an hour or two, and may recur infrequently, often years apart.
• Dysfunctional gallbladder or chronic gallbladder disease. The gallbladder becomes scarred from the gallstones and the repeated episodes of inflammation.
• Gallstones (cholelithiasis). Stones develop inside the gallbladder and can cause pain. However, about 90% of patients suffering with gallstones may have no symptoms, and may have had the stones present for a number of years. Studies indicate that if a patient has gallstones present for 10 or more years, they are less likely to cause symptoms.
• Inflamed gallbladder (cholecystitis). Inflammation of the gallbladder can be caused by gallstones – the most common cause – excessive alcohol use, infections, or even tumors that cause bile buildup. The gallbladder may rupture, which is cause for a surgical emergency.
• Sclerosing cholangitis. A disease of the bile ducts that causes inflammation of the liver, slowing the flow of bile to the gut. This can lead to cirrhosis of the liver, liver failure or even liver cancer.

Signs and symptoms of gallbladder disorders

The symptoms of a gallbladder disorder can vary depending on the type of condition. However, most symptoms start with pain in the upper abdominal area, either in the upper right or middle. Other common symptoms include:

• Chest pain
• Chills
• Clay-colored stool
• Feeling of fullness
• Heartburn, indigestion, and excessive gas
• Jaundice (yellowing of the skin and eyes)
• Pain that extends below the right shoulder blade or to the back; that worsens after eating a meal, particularly fatty or greasy foods; or a pain that increases when you breathe in deeply
• Tenderness in the abdomen, particularly the right upper quadrant
• Vomiting, nausea, fever

Diagnosis of gallbladder disorders

The first step in the diagnosis of a gallbladder disorder is to pinpoint the actual cause of the patient’s discomfort. Typically, a process of elimination is used to rule out any other disorders which might be mimicking a gallbladder attack, such as:

• Acute appendicitis
• Diverticulosis/Diverticulitis
• Gastroesophageal Reflux Disease (GERD)
• Heart attack. Often mistaken as a gallbladder attack.
• Hiatal hernia
• Inflammatory Bowel Disease (Crohn's disease)
• Irritable Bowel Syndrome
• Kidney stones
• Pancreatitis
• Pneumonia
• Pregnancy complications
• Stomach ulcers
• Ulcerative colitis
• Urinary tract infections
• Viral hepatitis

Your doctor will first conduct a complete medical history and physical examination. Diagnostic tests will be then be used to determine if the abdominal pain is caused solely by gallstones or another condition – one or more of the following techniques may be used:

• Abdominal X-ray
• Blood tests
• A computed tomography (CT) scan of the abdominal organs
• Endoscopic retrograde cholangiopancreatography (ERCP). A tube is placed down the throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder can be seen on X-ray.
• Endoscopic Ultrasound (EUS) – a specialized ultrasound probe placed on an endoscope which is used to image the gallbladder and biliary duct.
• HIDA scan. A radioactive material called hydroxy iminodiacetic acid (HIDA) is injected and is taken up by the gallbladder to measure gallbladder emptying function. This test also is referred to as cholescintigraphy.

Treatment of gallbladder disorders

Gallstones are typically managed through medical observation or removal of the gallbladder (cholecystectomy). Less commonly used treatments include sphincterotomy and extraction of gallstones or dissolving gallstones with oral medications.

Your gastroenterologist may also recommend a change in diet for the management of gallstones: 

• Coffee. Drinking coffee every day can lower the risk of gallstones; the caffeine is thought to stimulate gallbladder contractions and lower the cholesterol concentrations in bile.
• Fats. Although fats (particularly saturated fats found in meats, butter, and other animal products) have been associated with gallstone attacks, some studies have found a lower risk for gallstones in people who consume foods containing monounsaturated fats (found in olive and canola oils) or omega-3 fatty acids (found in canola, flaxseed, and fish oil). Fish oil may be particularly beneficial in patients with high triglyceride levels, because it improves the emptying actions of the gallbladder.
• Fiber. High intake of fiber has been associated with a lower risk for gallstones.
• Fruits and Vegetables. Studies have indicated that patients who consume a lot of fruits and vegetables may have a lower risk of developing gallstones that require gallbladder removal.
• High carbohydrates. Diets that are high in carbohydrates (such as pasta and bread) can also increase risk; carbohydrates are converted to sugar in the body.
• Nuts. Studies suggest that people may be able to reduce their risk of gallstones by eating more nuts (peanuts and tree nuts, such as walnuts and almonds).
• Sugar. High intake of sugar can increase the risk for gallstones.

As a comprehensive treatment measure for emergency cases or more serious gallbladder disorders, surgery may be required. Summa surgeons perform many gallbladder procedures including a Cholecystectomy, which is removal of the gallbladder using a minimally invasive approach, an open surgical approach or minimally-invasive, robotic-assisted surgery instead of a scope.

To schedule an appointment with a Summa physician to discuss treatment for your gastrointestinal condition, click or call 330.761.1111.