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What You Need to Know About Gallbladder Conditions

Compared to the heart, lungs or brain, the gallbladder isn’t an organ that most people often discuss. However, it still serves a very important function in the body. The gallbladder stores bile, or the digestive fluid, that is created in the liver. The bile is stored until you need it to help break down fat in your diet.

Whenever you eat foods that contain cholesterol or fats, your body will tell the gallbladder to contract. The contraction allows the bile to move down the main duct from the liver into the intestines where it meets the food and helps digest the fat.

However, sometimes this process doesn’t go according to plan and gallstones or other problems with the gallbladder can develop.  One of the most common disorders that affects the gallbladder are gallstones.

When this occurs, the overall consequences can range anywhere from mild discomfort, bloating or nausea after eating to very severe upper abdominal pain, which sometimes can spread all the way to your right shoulder or to your back. If you’ve never experienced gallstone disease or aren’t familiar with the signs and symptoms of this condition, here’s what you should know:

It Usually Starts with Abdominal Pain

The majority of people that come to my practice with gallbladder complaints are people who have experienced pain in their upper abdomen or upper right abdomen after eating, and sometimes this will wake them at night.

Commonly, the gallbladder is the source of their symptoms and it generally presents as problems that fall into one of two broad categories. The first would be gallstones, which is the most common problem and occurs when bile in the gallbladder hardens and forms stones that can block the cystic duct, or the passageway the removes bile from the gallbladder. These stones can lead to pain or symptoms that we call symptomatic cholelithiasis, the medical term for gallstones that are causing symptoms. Other, more complex problems related to gallstones are acute cholecystitis or common bile duct obstruction. 

The other broad category is called biliary dyskinesia, where a person’s gallbladder may not have gallstones, but it isn’t squeezing appropriately. This can lead to the abdominal pain and cause symptoms that typically occur after they eat fatty or spicy foods.

Symptoms Differ in Every Patient

Symptoms vary from patient to patient. Some people will have mild symptoms for months or even years until they finally seek treatment. Other people may have symptoms only once or twice a year or even weekly, but their symptoms never reach the level to where they need medical attention. In some cases, the first gallbladder attack or the pain or symptoms associated with their gallbladder disease can be so severe that it forces them to go to the ER. 

Occasionally, people will experience unusual symptoms such as heartburn, chest pain, indigestion, bloating, nausea or diarrhea. These symptoms can occur by themselves or in combination. If you are experiencing these symptoms it may be a diseased gallbladder contributing. However, it is always important to seek immediate medical attention if you are experiencing chest pain, as heart conditions can present with this symptom and can be life threatening. 

When this happens, it’s usually because the symptoms have not resolved on their own.  This is most commonly due to a gallstone that is blocking the exit to the gallbladder leading to inflammation or infection that requires surgical removal of the gallbladder. In more severe cases, the gallstones can pass out of the gallbladder and enter into the main duct that drains the liver, blocking the exit of that duct into the intestines. This can cause inflammation in the liver and the pancreas and symptoms like yellowing of the skin or eyes, fever, nausea or vomiting, which would lead to a more urgent medical situation and require hospitalization.

How We Treat Different Cases 

If a patient comes in and has had ongoing symptoms, the first test ordered is an ultrasound of the gallbladder, which helps us look at the gallbladder for signs of inflammation or signs that a patient does have stones or sludge that may be causing their symptoms. We may also order blood tests to make sure their liver is functioning appropriately and that there aren’t any signs the gallstones are causing more concerning problems. If those tests are all negative, sometimes we move onto what’s called a HIDA scan, which is a nuclear medicine scan where a patient is given a special dye into the IV and we watch the contrast flow from the liver down into the gallbladder and then get squeezed out of the gallbladder. We can then measure how effectively the gallbladder is squeezing.

If someone develops sudden severe symptoms, in most cases, we will surgically remove the gallbladder if it’s inflamed to the point that it causes worsening symptoms or lab abnormalities.  This is called acute cholecystitis. We usually take the gallbladder out in the first three days, if possible, because that’s when the surgery itself is the safest. Most commonly we can use minimally invasive surgery or less commonly open surgery. In most cases laparoscopic approach can allow same day or next day discharge. Open surgery will sometimes require a two or three day hospitalization. Usually 95 percent or more of patients undergo laparoscopic surgery, which only requires four incisions. The remaining five percent or less will require open surgery with a larger incision under their right ribs. In a very small number of cases, we may give the patient antibiotics first and then take the gallbladder out a few weeks later, but that’s rare. Typically, surgery is safest when it’s done soon after the onset of severe symptoms.

Most people who have their gallbladder removed won’t notice any difference in their lives other than the fact that they can return to eating the foods that may have caused symptoms like bloating, nausea and abdominal pain in the past. A very small percentage of patients will experience symptoms like diarrhea after gallbladder removal, but this is rare and usually resolves spontaneously. The majority of the time, the body will adjust and it will go back to functioning normally.

About 10 to 15 percent of Americans will have gallstones. Unfortunately, there’s not a sure-fire way to prevent gallstones. The Western diet, which is generally higher in cholesterol than the typical diet in other countries, contributes to this. There also are several risk factors for gallstones: women are more likely to develop gallstones than men; people over age 60 are more likely to have gallstones than younger people, and obesity, diabetes, high cholesterol, ethnicity, family history and blood disorders also can increase the risk of this condition.

Once you have developed symptomatic gallstones there is no medical treatment that effectively dissolves them or treats them long term other than removing the gallbladder.  

The best thing to do is pay attention to what your body is telling you. If you have ongoing symptoms, it never hurts to see a doctor and undergo tests to identify the underlying cause. And if you have severe symptoms that emerge out of nowhere, go to the ER immediately. This will enable us to identify the problem and remove the gallbladder as soon as possible if that is the cause of the symptoms.

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