Gallbladder Disease

Overview

What is gallbladder disease?

Gallbladder disease refers to any condition that affects the health of your gallbladder. Your gallbladder is a small organ in your digestive system. It stores some of the bile your liver makes and sends it to your small intestine to help break down food there. It does this through a series of pipes called bile ducts.

Gallbladder disease can begin in your gallbladder itself or in the bile ducts connected to it. Any infection or blockage in these ducts can back up into your gallbladder. Because the bile ducts connect your gallbladder with other organs in your digestive system, gallbladder disease can affect these other organs too.

What conditions affect the gallbladder?

Gallbladder diseases include:

  • Gallstones (cholelithiasis). Gallstones are the most common cause of gallbladder problems, but they don’t always cause problems. Gallstones develop when excess bile products in your gallbladder — usually cholesterol — accumulate into lumps, which can continue to grow and accumulate. You can have gallstones without symptoms and never know they are there. But they can cause problems if they block the flow of bile in the gallbladder or bile ducts.
  • Cholecystitis (inflammation). Cholecystitis is the most common symptom of gallbladder disease, and it can cause problems of its own. Cholecystitis (inflammation) can be a sign of an infection or blockage of the gallbladder, a functional obstruction or, more rarely, cancer. It’s most often caused by gallstones blocking the flow of bile. Chronic inflammation can cause scarring of the gallbladder tissue and, eventually, gangrene and even perforation (tearing).
  • Biliary dyskinesia. Also called functional gallbladder disorder, biliary dyskinesia is a motility problem. That means it's a problem with your gallbladder’s ability to move bile out into the bile ducts. A functional motility problem has the same effects as a gallstone or other obstruction in your gallbladder or bile ducts. It causes bile to back up in your gallbladder, leading to chronic inflammation. But in this case, it’s a mechanical problem, involving muscles or nerves.
  • Gangrene. Gangrene of the gallbladder is one of the more serious complications of chronic cholecystitis. Sustained swelling and distension of the gallbladder from chronic inflammation can eventually lead to tissue death. Dead tissues are at risk of bursting or tearing. A perforation in the gallbladder wall can put the rest of the abdominal cavity at risk of infection (peritonitis). This is one reason why it’s important to take cholecystitis seriously.
  • Gallbladder cancer. Cancer of the gallbladder or bile ducts is rare but serious. Because symptoms of gallbladder cancer often don’t appear until the later stages, healthcare providers treat any potential risk of gallbladder cancer proactively. Most gallbladder polyps (tumors or growths) are harmless. But if you have a polyp that's larger than average, your healthcare provider may recommend removing it just to be on the safe side.
  • Cholangiopathy. Cholangiopathy is any disease of the bile ducts. Cholangiopathy typically begins with inflammation of the bile ducts (cholangitis), which can result from a temporary infection, blockage or a progressive autoimmune disorder such as primary biliary cholangitis. Chronic cholangitis can result in scarring and narrowing of the bile ducts (biliary stricture). This can cause bile to back up into your gallbladder and liver.

How common is gallbladder disease?

Gallstones affect as much as 15% of the population, but only 20% of those with gallstones will have complications or symptoms. Gallbladder disease not associated with gallstones is much less common.

Who does gallbladder disease affect?

You are most likely to have gallbladder disease if you have gallstones. Risk factors include:

  • High cholesterol diet. Cholesterol gallstones, made up of extra cholesterol in the gallbladder, are the most common type.
  • Overweight and obesity. Excess weight causes your body to overproduce cholesterol — especially if you have a body mass index (BMI) over 30.
  • Age greater than 60. Gallstones are more frequent in people over the age of 60, probably because they’ve had more time for extra bile products to accumulate.
  • Assigned female sex. Women are more than twice as likely as men to develop gallstones. Extra estrogen, especially during pregnancy, increases cholesterol and slows gallbladder emptying.
  • Family history of gallbladder disease. About 25% of gallbladder diseases may be hereditary. Scientists have identified as many as twelve different genes that may be involved.
  • Native American or Mexican American heritage. These ethnicities have a 30% to 70% likelihood of developing gallstones, probably resulting from both dietary and genetic factors.
  • Diabetes. People with diabetes are two to three times more likely to have gallstones, possibly due to higher levels of fatty acids.
  • Crohn’s disease. People with Crohn’s disease are twice as likely to develop gallstones, due to their reduced ability to absorb bile salts that help break up cholesterol in the gallbladder.
  • Cirrhosis of the liver. This late-stage liver disease can slow the flow of bile from the liver to the gallbladder, causing buildup.
  • Sickle cell disease. This condition causes a build up of bilirubin in the gallbladder, leading to the less-common pigmented type gallstones.
  • Total parenteral nutrition. People who have to be fed intravenously for medical reasons are at risk of bile building up in the gallbladder from the lack of activity in the digestive system.
  • Cholesterol-lowering drugs. These medications reduce cholesterol in the blood but cause it to build up in the gallbladder.

What are the 5 Fs of gallbladder disease?

The five Fs were a mnemonic device that healthcare providers used in the past to memorize common risk factors for gallbladder disease. The five Fs were: fair, female, fat, fertile and 40. They were based on statistics, but they are controversial today because they add up to a kind of stereotype. If healthcare providers are looking for a specific profile when diagnosing gallbladder disease, they might be misled to jump to conclusions, overlooking patients who don’t fit the profile or overlooking other possible diagnoses in patients who do. However, the five Fs do reflect common risk factors.

“Fair” is based on the fact that white populations are more often affected by gallbladder disease. This might be partially genetic, or it might have more to do with the modern Western diet. “Female” is based on the fact that women are more than twice as likely to be affected. “Fat” is a generalization of people who may have a high-cholesterol diet or people who may have diabetes. “Fertile” is based on the fact that women who are or have been pregnant are more likely to have been affected by high estrogen. And “forty” is based on the fact that risk increases with age, so people who are at least forty are more likely to have it.

How does gallbladder disease affect my body?

When the gallbladder can’t do its job, bile can’t flow to your small intestine to help with digestion, and instead builds up in your blood. Since bile in your small intestine is important for breaking down fats, you may have some digestive difficulties, especially digesting fatty foods. Since bile is also a carrier for toxins that the liver has filtered from your body, bile that builds up in your blood will make you sick. A sick gallbladder can also be intensely painful.

Most gallbladder diseases can be treated in surgery, either by removing gallstones or removing the whole gallbladder. Surgeons redirect the bile ducts to flow directly from your liver to your small intestine without stopping in the gallbladder first. In this way, digestive processes can continue normally and you can live well without your gallbladder. But complications of gallbladder disease to other parts of your body can be more lasting if they aren’t addressed early enough.

What are the complications of gallbladder disease?

Gallbladder disease can affect your bile ducts, liver or pancreas.

Cholangitis

Gallbladder disease can cause inflammation, infection and/or blockage of the bile ducts, especially if a gallstone passes from the gallbladder into the bile ducts. Any one of these things also tends to cause the others to follow. Over time, this can cause scarring and narrowing of the bile ducts, which will cause long-term bile flow problems.

Cirrhosis

When bile backs up into your liver, as a result of gallbladder problems or bile duct problems or both, it causes inflammation and eventually scarring of the liver (cirrhosis). This will do long-term damage to your liver’s functioning. Cirrhosis also causes complications to other organs.

Pancreatitis

A gallstone that travels from the gallbladder into the bile ducts and pancreas duct opening can cause a blockage that backs up into the pancreatic duct and the pancreas. This is a common cause of pancreatitis, inflammation of the pancreas. Severe or long-lasting pancreatitis can do long-term damage to your pancreas.

Symptoms and Causes

What are the signs and symptoms of gallbladder disease?

Symptoms of gallbladder disease fall into a few different categories.

Biliary colic

Biliary colic is a type of visceral pain associated with gallbladder disease. It’s usually the first symptom of something going on in your gallbladder. The name “biliary colic” implies that the bile ducts are involved, and they usually are, if not directly then by proxy. A blockage in either the gallbladder or bile ducts will cause pressure to build up in both. Most commonly, a gallstone causes a blockage. But swelling due to infection, biliary stricture or a problem with the emptying function of your gallbladder may also cause pressure to build up. The pain is proportional to the pressure.

It may begin as a dull ache that comes and goes, often in conjunction with gallbladder contractions after a meal. You’ll feel it in the upper right side of your abdomen under the right rib cage, where your gallbladder is located. You may also feel it in the middle of your abdomen, or it may radiate to the right shoulder blade. It’s typical to experience nausea and vomiting with biliary pain. An episode usually lasts a few hours and occurs intermittently but not every day. This indicates a partial or occasional blockage that may occur when your gallbladder contracts and eases when it relaxes.

Acute cholecystitis

A persistent blockage, infection or tumor in your gallbladder can cause acute inflammation, which feels like a more intense version of biliary colic. Nausea and vomiting may be accompanied by fever and chills. The pain is steadier and may be extreme enough to bring you to the emergency room. You may have an accelerated heart rate or abrupt drop in blood pressure during gallbladder contractions, such as after a meal. As blocked bile begins to accumulate in your blood, you may begin to show visible symptoms, such as jaundice, dark-colored pee and pale-colored poop.

Chronic cholecystitis

Chronic symptoms are often milder than acute symptoms and may go unnoticed for some time. You may only notice digestive difficulties, such as abdominal bloating and distension, chronic gas, nausea or diarrhea after eating. These symptoms have many possible causes that don’t necessarily point to the gallbladder. In the case of gallbladder cancer, you might have chronic inflammation with mild jaundice, but no pain. The vague nature of these symptoms, without alarming pain levels, can cause chronic cholecystitis to go undiagnosed, causing long-term damage.

What causes gallbladder disease?

Gallstones are the most common cause of gallbladder problems, but they don’t always cause problems. When they do, it’s usually because they block the flow of bile in your gallbladder, bile ducts or both. Less commonly, bile may back up because the emptying function of your gallbladder is sluggish, or because some other condition has made your bile ducts too narrow. Backed-up bile is the most common cause of gallbladder inflammation (cholecystitis), but sometimes a separate infection causes it. Inflammation makes your gallbladder swell and builds up pressure inside it. This can also cause bile to back up as a secondary effect.

Diagnosis and Tests

How is gallbladder disease diagnosed?

As always, your healthcare provider will begin with your medical history and review of your symptoms. They'll take your vital signs, observing any change in heart rate, blood pressure or body temperature, such as fever. Then they’ll examine you physically, looking for signs of jaundice and swelling in your abdomen. They might feel the abdominal area where your gallbladder is located. If they can feel your gallbladder, that’s a sign of inflammation. Whether it is painful to the touch or not may help distinguish between gallstone-related acute inflammation and cancer-related chronic inflammation. They will follow up with blood tests and imaging tests.

What tests are used to diagnose gallbladder disease?

  • Complete blood count. This test will look for high levels of white blood cells, which indicates infection or inflammation.
  • Liver function tests. These blood tests can help detect blockages in the bile ducts.
  • Pancreas function tests. These blood tests can help detect a blockage of the pancreatic duct.
  • Abdominal ultrasound. This noninvasive imagining test can reveal inflammation, blockages or growths in the gallbladder or bile ducts.
  • HIDA scan. Also called a cholescintigraphy scan, this imaging test measures the emptying function of the gallbladder into the small intestine and the flow of bile through the bile ducts.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP). This endoscopic imaging test combines X-ray technology with endoscopy, the use of a lighted camera on the end of a long tube. During the exam, the endoscope is placed down your throat into your abdomen, where it can see your organs. Fluoroscopic X-rays help visualize the bile ducts. If the test reveals a blockage, your healthcare provider may be able to treat it on sight by inserting tiny instruments through the endoscope.
  • Endoscopic Ultrasound (EUS). This endoscopic imaging test combines ultrasound technology with endoscopy, the use of a lighted camera on the end of a long tube. During the exam, the special endoscope that has ultrasound technology at the tip of the endoscope is placed down your throat into your abdomen, where it can see your organs. Through ultrasound technology, the endosonographic images help visualize the bile ducts, pancreas, gallbladder and liver. If the test reveals an abnormality, your healthcare provider may order different testing/procedures to treat the issues.

Management and Treatment

How is gallbladder disease treated?

  • Pain medication. Acute episodes of biliary colic, or “gallbladder attacks,” often require prescription pain medication to manage. Your healthcare provider will help determine the right medication for you, based on your medical history and symptoms.
  • Antibiotics. If you have an infection, your healthcare provider will prescribe antibiotics to treat it. This is often only a precursor to surgical treatment.
  • Endoscopic intervention. Your healthcare provider may be able to fix minor gallbladder problems using an endoscope, before resorting to surgery. An ERCP and/or EUS exam can reveal blockages, tumors and stones that may be causing problems. During the exams, your healthcare provider may be able to remove gallstones, place stents to open up bile ducts and take tissue samples for biopsy, using instruments on the end of the endoscope.
  • Surgery. The only permanent and effective solution for persistent gallbladder disease is gallbladder removal surgery (cholecystectomy). This is a common treatment, and you can live well without your gallbladder. Most people can have their gallbladder removed through minimally-invasive laparoscopic surgery. A laparoscopic cholecystectomy requires only a few small incisions. More complicated cases of infection or gallbladder cancer may require open surgery.

Prevention

How can I reduce my risk of gallbladder disease?

Not all risk factors are in your power to control, but you can optimize your gallbladder health by maintaining a healthy diet and lifestyle. The modern Western diet is high in fats and cholesterol and low in fiber, which helps clear excess fats from the body. Make an effort to reduce fatty processed foods and eat more fiber-rich plants. Regular exercise can also help reduce your risk by encouraging your motility — the regular contractions of your digestive organs.

Outlook / Prognosis

What can I expect if I have gallbladder disease?

Most gallbladder disease ends in surgery (gallbladder removal), but you’ll be in good company if it comes to that. Most people recover quickly and don’t have long-term side effects from the surgery. You may have some temporary digestive difficulties while recovering. You might have to avoid fatty foods at first while your body is adjusting to the lack of a gallbladder. Most people are able to resume a normal but healthy diet after a few months.

A note from Cleveland Clinic

Gallbladder disease can sneak up on you. By the time you have symptoms, it may already be serious. Fortunately, most gallbladder diseases are easily treated with minimally-invasive surgery. The important thing is to take symptoms seriously, even if they aren’t severe. You may have mild passing biliary pain that seems to resolve itself, but this can become a persistent and growing problem. Don’t wait for the intense alarm symptoms of acute cholecystitis, or for the long-term damage caused by chronic cholecystitis. Your healthcare provider can locate and often remove problematic gallstones through common outpatient testing procedures.

Last reviewed by a Cleveland Clinic medical professional on 05/03/2022.

References

  • American College of Gastroenterology. Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis. (https://gi.org/topics/biliary-tract-disorders-gallbladder-disorders-and-gallstone-pancreatitis/) Accessed 5/3/2022.
  • MedlinePlus. Gallbladder Diseases. (https://medlineplus.gov/gallbladderdiseases.html) Accessed 5/3/2022.
  • Merck Manual Consumer Version. Overview of Gallbladder and Bile Duct Disorders. (https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/gallbladder-and-bile-duct-disorders/overview-of-gallbladder-and-bile-duct-disorders) Accessed 5/3/2022.

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