Gallbladder Disease

What is the gallbladder?

The gallbladder is a small pear-shaped organ located in the right upper quadrant of your abdomen under your liver. Its main function is to store bile produced by the liver and release it via a duct into your small intestine, where bile is used to help you digest fats. There are many different types of gallbladder disease.

1.Gallstones

What are Gallstones?
Gallstones develop when substances in the bile (cholesterol, bile salts, and calcium) or blood (bilirubin) form hard particles or “stones”. These stones can move out of the gallbladder and block the passageways to the gallbladder and bile ducts and even become lodged in the pancreatic duct causing gallstone pancreatitis. 

Why do Gallstones form?
Gallstones tend to form when the gallbladder doesn’t empty completely or often enough. Gallstones can also form if bile contains too much cholesterol, bilirubin, or not enough bile salts.

What are some risk factors for developing gallstones?

  • Individuals of certain ethnic backgrounds are at increased risk (For example, being Native American or Mexican-American)
  • Being overweight or obese
  • Having a history of rapid weight loss
  • Having diabetes, pre-diabetes or insulin resistance
  • Being older than 40
  • Being female
  • Taking medications that contain estrogen (like birth control pills)
  • Having a family history of gallstones
  • Having Crohn’s disease 
  • Having Celiac disease
  • Having cirrhosis of the liver or other liver diseases
  • Other certain conditions that are associated with infrequent gallbladder emptying such as being on total parenteral nutrition 

What are the symptoms of Gallstones?
Many patients will be asymptomatic. Classic symptoms include:

  • Severe, colicky right upper quadrant abdominal pain that comes and goes in waves
  • Nausea and vomiting 
  • Fever
  • On physical exam, there may be pain over the right upper quadrant (called Murphy's sign).

How are Gallstones Diagnosed?
Typically by abdominal ultrasound, which typically shows a thickened gallbladder and/or stones or sludge. 

Lab tests, including liver function tests and a white blood cell count, may be useful especially if there is coinciding inflammation or infection in the gallbladder.

How are Gallstones Treated?
Symptomatic gallstones are treated by removing the gallbladder. Today, this procedure is often done laparoscopically through a minimally invasive procedure that requires only small incisions. This is not always an option for all patients, though. 

Patients who have severe or persistent abdominal pain and develop fever or an elevated white blood cell count will need to be seen for surgical consultation urgently. If your symptoms have resolved and there is no concern for infection or other emergent conditions, you may be able to proceed with elective cholecystectomy. This decision can only be determined by a trained medical professional so if you have any concern regarding gallstones or gallbladder disease please call our office promptly for a comprehensive medical evaluation or go to your nearest emergency department. 

2. Cholecystitis 

What is Cholecystitis?
Cholecystitis is inflammation of the gallbladder or irritation of the gallbladder walls. It can be acute or chronic. Acute cholecystitis occurs suddenly. Chronic cholecystitis is more longstanding and causes several attacks. 

What causes Acute Cholecystitis?
By and large, the most common cause of acute cholecystitis is gallstones blocking the tube leading out of your gallbladder resulting in bile build-up in the gallbladder and inflammation. 

About 10% of cholecystectomies performed annually are for acalculous cholecystitis, meaning inflammation in your gallbladder not caused by gallstones. This could occur for any number of reasons including bile duct problems, tumors, lack of appropriate blood supply to your gallbladder, serious illness, and certain infections.

What are the symptoms of Acute Cholecystitis?
Classic symptoms include: 

  • Right upper quadrant abdominal pain that tends to occur after meals, especially fatty or heavy meals, is colicky, comes and goes suddenly, and comes in waves, and may radiate to your right shoulder. 

Other symptoms include:

  • Fever
  • Nausea, Vomiting, and
  • Jaundice 

Chronic cholecystitis is more longstanding and occurs as several attacks of acute cholecystitis. It usually occurs when the gallbladder shrinks and loses its ability to store and release bile and function properly. 

Common symptoms include: 

  • Right upper quadrant abdominal pain, 
  • Nausea and Vomiting. 

What are the risk factors for Cholecystitis?

  • Being female,
  • Being over 40 years of age,
  • Being Obese, 
  • Being Elderly,
  • Pregnancy,
  • Certain ethnic populations (such as Northern European and Hispanic), 
  • Having a history of rapid weight loss, 
  • Family history,
  • Being a liver transplant patient

How is Cholecystitis Treated?
Treatment often involves surgical removal of the gallbladder.

3. Gallbladder polyps

What are Gallbladder Polyps?
Gallbladder polyps are lesions or growths found inside the gallbladder that protrude from the inside lining of the gallbladder. They’re usually benign and have no symptoms. About 95% of gallbladder polyps are benign; however, they can be cancerous. Surgical removal is sometimes recommended, especially if the polyps are large. This is because the larger the polyp the greater the chance it may be cancerous.

What are the risk factors for Gallbladder Polyps?
It’s unclear what exactly causes gallbladder polyps. Genetics and fat metabolism may play a role. 

What are the symptoms of gallbladder polyps?
Most gallbladder polyps are incidental findings, meaning they are diagnosed during a medical procedure performed for an unrelated condition (such as an abdominal ultrasound or CT scan). 

The vast majority of patients do not have any symptoms.  

How are gallbladder polyps diagnosed?
Typically these are incidental findings diagnosed during a medical procedure performed for an unrelated condition (such as an abdominal ultrasound or CT scan). Sometimes they’ll be found during endoscopic ultrasound or EUS. 

What is the risk for a gallbladder polyp turning into cancer?
Larger polyps in older patients are more concerning for malignancy; however, imaging studies or laboratory tests can definitively distinguish a benign polyp from a malignant polyp. If there concern regarding a polyp’s malignant potential or if it’s your preference surgical consultation is an option.  

What are the treatment options for gallbladder polyps?
Surgical consultation and removal of the gallbladder may be advised depending on the size and characteristics of the polyp. Smaller polyps may be closely followed and monitored with routine surveillance imaging studies such as ultrasound depending. 

*The best treatment approach and surveillance schedule for your individual case should be discussed with our trained medical staff. 

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