What is Gallbladder Disease?
Gallbladder disease is a term used to describe an inflamed, infected, or simply just poorly functioning gallbladder. These problems have various causes, but the symptoms in most cases are similar. The gallbladder is found below the liver, and its job is to store and sometimes release extra bile before it is transported down the bile duct to the small intestine to be used for digesting food.
What are the Symptoms of Gallbladder Disease?
Pain
You may experience pain in the upper middle or upper right side of the abdomen. The pain may be mild to acute. Sometimes it can disappear after a few minutes while in severe conditions, the pain can be unbearable and can spread to the chest, mid abdomen, and the back.
Jaundice
A yellow hue in the eyes or skin can be as a result of liver inflammation or due to gallstones that block the free movement of bile from the liver and the gallbladder to the intestines.
Nausea and Vomiting
A dysfunctional gallbladder causes disruption of the normal digestive process and nausea and even violent vomiting is a hallmark of gallbladder disease.
Diarrhea
Loose stool can be a result of inadequate or even too much bile reaching the intestine due to gallbladder dysfunction.
Constipation
Constipation Is a less typical symptom of gallbladder disease, but possible symptom of gallbladder disease. Stool with hardly any color may suggest a bile blockage and very orange or very dark appearing urine may also be a symptom of no bile reaching the intestine.
Fever
This is more common when an infection is the cause of gallbladder disease. The fever may alternate with chills.
What are the Causes of Gallbladder Disease?
The Primary Cause of Gallbladder Disease is Gallstones
Gallstones may occur in men and women, but are bit more common in women as pregnancy predisposes to gallstone formation. The stones in the gallbladder can harbor bacteria on their surfaces which antibiotics are not able to eradicate. This is the primary cause of a gallbladder infection, but it is also possible to have an infection within the gallbladder without stones. This is known as acalculous cholecystitis. If gallstones migrate out of the gallbladder and block the outflow of bile from the gallbladder or even the liver, much worse symptoms result. If the gallbladder outflow is blocked, pressure can build up in the gallbladder causing pain, distension of the gallbladder and sometimes rupture.
Genes
The causes of gallbladder disease disease can be hereditary.
Digestive Problems with Gallbladder Disease
When the gallbladder cannot empty bile on time, this will lead to symptoms. The pressure on the organ can cause pain and possibly even cause the gallbladder to rupture. Bile must be available in the small intestine to help digest fats found in food. Fats and oils can only be digested when bile is present. Therefore dairy products such as butter, milk, cheese, and oils such as olive oil or vegetable oil can only be digested if adequate bile is present. Even the fats in nuts and some vegetables like avocados require bile to be digested.
Diet, Alcohol Intake, and Diabetes Can Lead to Gallbladder Disease.
These are just some of the many reasons that can cause disease. Unhealthy diets such as refined foods, sugars, and excess fatty foods are key diet causes of gallbladder problems. Diabetics also unfortunately have increased incidences of Gallbladder Disease?
How Common is Gallbladder Disease?
In Sweden, it is estimated that at least 40% of the population will develop gallstones at some point in their life compared to 10% in America. Northern Europeans, American Indians, and hispanic populations have increased risks of developing gallstones. The Pima Indians of Arizona have the highest prevalence rate at 80%. Asian populations and African populations have a slightly decreased risk, but gallstone disease is so common that many people with these ethnicities still develop gallstones. This highlights the hereditary component of gallbladder disease.
How is Gallbladder Disease Diagnosed?
The symptoms, or patient’s history is the first factor that suggests gallbladder disease. Certain findings on physical exam and certain imaging studies can then confirm the presence of gallbladder disease.
The Murphy Test
A Murphy sign is a particular examination tool that is specific for gallbladder disease. The Murphy sign is elicited during a maneuver where the medical provider puts pressure with their fingertips directly under the right side of the rib cage, pushing firmly upwards and deeply while the patient takes a deep breath. This causes the diaphragm to drop lower which pushes the liver and the gallbladder downward onto the outstretched fingers of the medical provider which are under the patient’s right rib cage. If the patient is unable to finish the deep breath due to pain and pressure (an inspiratory arrest) the a Murphy sign is present. This is indicative of gallbladder disease.
Blood Tests
Liver function tests or a comprehensive metabolic panel is used to determine the amount of bile or liver enzymes in the blood. Although this is not a conclusive test on its own, it gives more information regarding the presence of liver or gallbladder disease. Most often, an additional lab test also checks for the presence of too many white blood cells in the blood which could suggest inflammation or infection.
Scans
Abdominal ultrasound or CT scans can be performed to detect the presence of gallstones and any inflammation in the gallbladder all the ducts. Gallbladder infections can also be detected through ultrasound or CT scan. Ultrasound is the primary method employed to detect the presence of gallstones as it is more sensitive than CT, is cheaper, and does not expose the patient to radiation. However, the CT scan may provide more information about other organs which could be causing the patient's symptoms and CT evaluates the pancreas better if there is a question about pancreatic involvement.
How is Gallbladder Disease Treated?
Surgery is the mainstay of treatment of gallbladder disease because other treatments such as medicines tend to result in recurrences of the same problems down the road while surgery removes the offending organ. Gallbladder surgery used to mean a long scar and 3 to 5 days in the hospital. But today, when the operation usually takes less than an hour, most people return to work within a week, and it is so safe and effective, it has become the go to treatment instead of delay and continues symptoms.
Laparoscopic Cholecystectomy
With this procedure, doctors make 3 to 4 small incisions in the abdomen, insert a telescope camera and instruments to remove the gallbladder. Since surgeons make only tiny incisions, the recovery period is reduced. The patient is usually in the surgery center or hospital for a few short hours and does not need to spend the night.
Open Cholecystectomy
This surgery should just about never be the plan anymore for an elective gallbladder operation. The only reasons to proceed with an open cholecystectomy now should be the suspicion of a cancer which will require extra,added dissection, a known situation where scar tissue precludes the use of laparoscopic approaches or some other very atypical situation. Just because an infection is present or the patient is very ill does not mean that an open cholecystectomy should be planned. The surgeon may have to convert a laparoscopic gallbladder operation to an open gallbladder operation if excessive scar tissue is encountered, or if significant bleeding is encountered which cannot be controlled laparoscopically, or if there are stones down low in the common bile duct which cannot be removed with endoscopic means. An open gallbladder operation involves cutting the abdomen just below the right rib cage to remove the gallbladder. The patient then usually has to stay in the hospital for a few days.
Drugs for Gallstones
Some drugs used to dissolve gallstones include Actigall and Chenodiol. They work to dissolve cholesterol stones, but they have to be taken for a longer period and may not be effective. They can be expensive and can have side effects. There is also significant possibility of the stones forming again once the medication is stopped.
What are the Complications of Gallbladder Disease?
Even today, people still die of gallbladder disease. Most often complications are pain and misery until treatment is performed. However, blockage of bile or pancreatic enzymes by an obstructing gallstone can lead to a very sick patient requiring an ICU stay, possible need of a ventilator, days without nutrition, and damage to other organs such as the liver and kidneys. Gallstone disease is best treated before the patient experiences an infection or a migration of stones down the bile ducts which greatly increases the chances of bad problems, costs of treatments, and failure of certain treatments.
Expected Recovery Outcomes
Most people who undergo Laparoscopic Cholecystectomy can go back to their regular duties after a week while those who go through open surgery may have to wait longer. The discomfort may last up to 3 weeks. A regular diet should be able to be tolerated even the day after the operation. Some patients may notice some change in bowel habits such as an increase in loose stools during the first week to 3 weeks after removal of their gallbladder. This does not happen to most patients and when it does it usually greatly improves in the first 2 to 3 weeks after the operation. If this problem persists for several weeks, consult your doctor.