Gallbladder Disease

What the gallbladder does

The gallbladder is a pear-shaped sac, about 3 to 4 inches (8 to 10 cm) long, tucked under the liver on the right side. The liver makes bile continuously. Between meals, bile is stored and concentrated in the gallbladder. When you eat, especially fat, the gallbladder squeezes bile through the bile ducts into the small intestine to help digest fat.

Problems arise when stones form, when the gallbladder or ducts become blocked or inflamed, or, less often, when the gallbladder does not empty properly. You can live normally without a gallbladder, because bile then flows straight from the liver into the gut.

Types of gallbladder disease

Gallstones (cholelithiasis)

Hard deposits form when bile contains too much cholesterol or bilirubin. Most are cholesterol stones. Gallstones range from grains of sand to golf-ball size. About 80% cause no symptoms and need no treatment.

Biliary colic (gallbladder attack)

Biliary colic happens when a stone temporarily blocks the gallbladder outlet while it squeezes. The pain is steady rather than coming in waves, despite the name.

Cholecystitis

Cholecystitis is inflammation of the gallbladder, usually because a stone stays stuck in the outlet. Pain lasts longer than 6 hours and comes with fever, tenderness and raised white cells. Rarely it occurs without stones (acalculous cholecystitis), mainly in very ill hospital patients.

Bile duct stones and cholangitis

A stone that slips into the common bile duct (choledocholithiasis) blocks bile flow from the liver, causing jaundice, dark urine and pale stools. Infection behind the blockage, called cholangitis, causes fever, chills and jaundice and is an emergency.

Gallstone pancreatitis

A stone that blocks the outlet shared by the bile and pancreatic ducts can trigger acute pancreatitis, with severe upper belly pain going through to the back.

Biliary dyskinesia

Typical gallbladder pain without stones, with a gallbladder that empties poorly on a HIDA scan. See biliary dyskinesia.

Polyps and gallbladder cancer

Gallbladder polyps are small growths on the lining, usually harmless. Polyps of 10 mm or more, or growing ones, are usually removed because of a small cancer risk. Gallbladder cancer is rare in the US and is often found late or by chance after surgery.

Gallbladder symptoms

Attacks often start in the evening or at night, sometimes after a large or fatty meal, and may come with nausea and vomiting. Vague bloating, belching and indigestion are common but are not reliable signs of gallbladder disease. Removing stones often does not cure those symptoms, which overlap with indigestion and reflux.

Causes and risk factors

• Female sex: women are about twice as likely as men to develop gallstones, because estrogen raises cholesterol in bile. Pregnancy, birth control pills and hormone therapy add to the risk.
• Age over 40.
• Obesity, and rapid weight loss, including after weight-loss surgery or very low-calorie diets.
• Family history and ancestry: rates are especially high in Native American and Mexican American people.
• Diabetes and high triglycerides.
• Liver cirrhosis and hemolytic anemias such as sickle cell disease, which cause pigment stones.
• Long periods without eating, including intravenous nutrition.

Gallbladder disease in women

Gallstones are most common in women in their 40s, especially after several pregnancies. Pregnancy slows gallbladder emptying, and attacks can occur during pregnancy or in the months after birth. Surgery during pregnancy is usually timed for the second trimester if needed.

How it is diagnosed

• Abdominal ultrasound: the first and best test for gallstones and cholecystitis. It is quick, painless and uses no radiation.
• Blood tests: white cell count for infection, liver tests and bilirubin for duct blockage, and lipase for pancreatitis.
• HIDA scan: a nuclear medicine scan that shows whether the gallbladder fills and empties. Used for suspected cholecystitis when ultrasound is unclear and for biliary dyskinesia.
• MRCP: an MRI of the bile ducts that detects duct stones without instruments.
• Endoscopic ultrasound (EUS) or ERCP: a camera passed through the mouth. ERCP can also remove duct stones.
• CT scan: for complications and other causes of abdominal pain.

Treatment

No symptoms: usually no treatment

Gallstones found by chance are generally left alone. Each year, only a small proportion of people with silent stones develop symptoms.

Removing the gallbladder

Laparoscopic cholecystectomy (keyhole surgery through 3 or 4 small cuts) is the standard treatment for recurrent attacks, cholecystitis, gallstone pancreatitis and large polyps. Most people go home the same day or next day and return to normal activity in 1 to 2 weeks. For acute cholecystitis, surgery is usually done during the same hospital stay.

Treating bile duct stones

ERCP removes stones from the common bile duct, often followed by gallbladder removal to prevent repeat episodes. Cholangitis also needs antibiotics and urgent drainage.

Other options

• Ursodiol tablets can slowly dissolve small cholesterol stones over months in people who cannot have surgery, but stones often come back after stopping.
• Drainage tube (cholecystostomy) through the skin, for very ill people too frail for surgery.

Pain during an attack

Doctors use anti-inflammatory painkillers or stronger pain relief. Do not rely on over-the-counter painkillers to manage repeated attacks at home without a diagnosis.

Life after gallbladder removal

Most people eat normally afterward. Some have looser stools or diarrhea after fatty meals for a few weeks to months, which usually settles. A small number continue to have pain, which may come from a retained duct stone or another problem and should be checked.

Prevention

You cannot fully prevent gallstones, but you can lower the risk:

• Keep to a healthy weight and avoid crash diets. Aim to lose weight gradually, about 1 to 2 lb (0.5 to 1 kg) a week.
• Stay physically active.
• Eat regular meals with fiber, and limit refined carbohydrates.
• People losing weight very quickly, such as after bariatric surgery, may be prescribed ursodiol to prevent stones.

Frequently asked questions

What are the first signs of gallbladder problems?

The first sign is often a gallbladder attack: sudden, steady pain under the right ribs or in the upper middle belly, sometimes spreading to the right shoulder blade, lasting from 30 minutes to a few hours. Nausea and vomiting are common. Many people with gallstones have no symptoms at all.

What does a gallbladder attack feel like?

It feels like a constant, gripping or pressing pain high in the belly, usually on the right or in the middle, that builds over minutes and stays intense. It may wake you at night, often follows a large meal, and can spread to the back or right shoulder. Moving around does not ease it.

Can gallbladder disease go away on its own?

A single gallbladder attack settles on its own, but stones usually stay and attacks tend to recur. Silent gallstones may never cause trouble. Complications such as cholecystitis, duct stones and pancreatitis do not resolve safely without medical treatment.

When is gallbladder pain an emergency?

Get emergency care if pain lasts more than 6 hours, or comes with fever, chills, yellow skin or eyes, severe pain into the back, persistent vomiting or confusion. These suggest cholecystitis, a blocked or infected bile duct, or pancreatitis.

Can you live a normal life without a gallbladder?

Yes. After removal, bile flows directly from the liver into the intestine. Most people eat a normal diet within weeks. Some have looser stools after fatty meals for a while. No special lifelong diet is needed for most people.

Why is gallbladder disease more common in women?

Estrogen increases the amount of cholesterol in bile and slows gallbladder emptying, which both encourage stone formation. That is why pregnancy, birth control pills and hormone therapy raise the risk, and why women in their 40s are one of the most affected groups.