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Gallbladder diseases

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The gallbladder is an organ found just below the liver. It is a sac responsible for the storage of bile manufactured by the liver. The gallbladder releases the bile to aid in the digestion of fats in the duodenum (the top portion of the small intestine). When there is an underlying condition which impedes the flow of bile from the gallbladder, gallbladder disease can occur.

GALLBLADDER DISEASES SIGNS AND SYMPTOMS

Gallbladder disease can lead to inflammation and infection caused by the formation of gallbladder stones which add to gallbladder obstruction. Gallbladder disease is also known as biliary disease, cholescystitis, common bile duct stones, choledocholithiasis, or lithotripsy.

When the gallbladder becomes inflamed, it is a sign that choliths (gallstones) have formed. One out of twenty cases of gallbladder inflammation is caused by gallstones. These gallstones start out as fluid bile containing clumps of fatty substances, bile salts and bilirubin that can harden and solidify, particularly if the bile fluid contains excess amounts of cholesterol. Sometimes pigments from the bile and excessive calcium deposits also coagulate into gallstones. These particular gallstones are known as pigment stones and commonly afflict people who have a pre-existing liver ailment, like cirrhosis of the liver, where an excess of bilirubin is produced.

Over 20 million people in the United States are diagnosed with gallstones every year, with about 300,000 of those diagnosed succumbing to complications of the disease.

There may be just one large gallstone, or several small ones. Gallstones affect more women than men, and become more common as people age. Most people who have gallstones are usually not aware of them because of the lack of symptoms. While a majority of stones remain in the gallbladder and are basically harmless, they can eventually cause problems.

Gallstones can block the cystic duct, a tube responsible for draining bile from the gallbladder, and prevent bile from passing into the gallbladder itself. This causes the gallbladder to become distended and inflamed. The inflammation in turn causes a secondary infection by E. coli and Bacteroides, which occurs in 20% of all cases of gallbladder disease.

This infection of the gallbladder walls (cholecystitis) may spread to the diaphragm and bowel. In severe cases of chronic Cholecystitis, the infection causes death of the surrounding tissues (necrosis) and even a rupture.

There are rare debilitating instances when the infection is not caused by cholethiasis (gallbladder stones), and this condition is known as acute acalculous cholecystitis.

Acute gallbladder disease can become fatal if the infection spreads to other parts of the body, a condition known as septicemia. If a gallstone obstructs the pancreatic duct, a painful inflammation known as pancreatitis may occur. Other complications include gangrene (tissue decay), fatal cases of perforated gallbladder, pus formation (empyema), and fistula, where the gallbladder becomes stuck to other neighboring organs and a passageway forms between them.
gall bladder disease
Image: Gall bladder disease

GALLBLADDER DISEASES RISK FACTOR

Risk factors for gallbladder disease include being at the age of 40 and above, obesity, frequently going on fad diets that cause rapid weight loss, kidney failure, gallbladder cancer, cirrhosis of the liver, and multiple pregnancies in women.

Ninety percent of people with gallstones have no symptoms at all. These people are referred to as asymptomatic because they have “silent stones” which do not interfere with the functions of the gallbladder, liver or pancreas. These gallstones do not require medical treatment.

When there are problems brought about by gallstones, Cholecystitis sufferers usually start to feel the beginning symptoms of the disease as a severe and steady pain on the upper right portion of their abdomen just under the ribs that travels up to the right shoulder and into the back. The pain usually lasts from 30 minutes to several hours, and intensifies whenever the affected person inhales deeply. There will also be a slight fever, abdominal bloating, belching or colic, indigestion, nausea and vomiting, and diarrhea.

These symptoms usually take around 8 years to develop, and occur at night following a meal of fatty foods or fluids.

Immediate medical attention is needed when a person has a very high temperature, starts to sweat and breaks out in chills, exhibits jaundice and signs of shock, and expels clay-colored stools. These are severe symptoms which indicate complications such as gallbladder abscesses and perforation, or fistula.

Most gallstones that exhibit no symptoms are usually discovered through unrelated x-rays, in surgery, and even during autopsy. Abdominal examinations known as palpitations will usually result in tenderness in the area where the gallbladder is located.

GALLBLADDER DISEASES DIAGNOSIS

In people exhibiting symptoms, a doctor can detect inflammation and the existence of gallstones through tests like an abdominal ultrasound, CT scan or x-ray, ordering a blood test to check for an elevated white blood cell count, oral cholecystogram (gallbladder x-ray), an endoscopic retrograde cholangiopancreatography (ERCP), or a gallbladder radionuclide scan.

Other diagnostic tests include hepatobiliary scintigraphy (taking images of the liver, bile ducts, gallbladder and duodenum), cholangiography (using contrast intravenous dye in an x-ray test), and percutaneous transhepatic cholangiography (taking x-rays of the bile duct using an injected contrast dye).

GALLBLADDER DISEASES TREATMENT

To treat gallbladder disease, the doctor may recommend oral dissolution therapy where drugs manufactured from bile acid are taken to dissolve gallbladder stones. An injectible solution of methyl-tert-butyl ether can also accomplish this goal, as with extracorporeal shockwave lithotripsy (ESWL), in which shock waves are used to break down gallbladder stones into smaller particles that can pass out the bile ducts without causing any blockages.

One procedure called a laparoscopic cholecystectomy involves a tiny incision to remove gallstones. In some cases, a cholecystectomy (gallbladder removal) procedure may be required to allow bile to pass from the liver directly to the small intestine.

GALLBLADDER DISEASES PREVENTION

To lower the risk of developing gallbladder disease, keeping an ideal weight, reducing the fat and sugar in one’s diet, regular exercise, and increasing the consumption of high-fiber foods (oat bran, wheat bran, soy fiber, fruits and vegetables) and foods rich in vitamin C will help.


There is also evidence that high-dose contraceptive pills and estrogen therapy taken by women during menopause can increase their risk for gallstone formation.

GALLBLADDER DISEASES PROGNOSIS

The prognosis for gallbladder disease is excellent, unless complications develop, usually in 20% of Cholecystitis cases. With complications such as gallbladder perforation or gangrene, the mortality rate rises 50 to 60%. Cholecystectomy is a low-risk procedure, and in most instances 99% of patients do not experience a recurrence of symptoms.

The Harvard School of Public Health has published its findings in the Journal of the American Medical Association, that drinking coffee can reduce the risks of acquiring symptomatic gallstones by 40%.

Recent research has also discovered that non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin or ibuprofen can protect against gallstones. Another drug approved by the FDA, Actigall, can actually prevent their formation in obese patients.
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