Gallbladder Disease - symptoms and treatment

Gallbladder Disease - symptoms and treatment

What is Gallbladder Disease

Gallbladder Disease - disorders and dysfunctions of the GALLBLADDER. Gallbladder disease becomes more common with increasing age. Though medical treatments can help some people with gallbladder disease, surgery to remove the gallbladder is the most common treatment and permanently resolves symptoms in about 90 percent of people who have primary gallbladder disease. Tumors and CANCER of the gallbladder occur, though are very rare. INFLAMMATION of the BILE DUCTS and HEPATITIS also can affect BILE production and gallbladder function. Gallbladder disease can be acute or chronic.

Biliary dyskinesia

Dysfunction of the gallbladder prevents it from contracting to eject bile, reducing or stopping the flow of bile from the gallbladder to the DUODENUM (first segment of the small intestine). Biliary dyskinesia may occur as a result of injury to the nerves that supply the gallbladder, as a consequence of metabolic disorders affecting LIVER function, or for unknown reasons (most common).

Cholelithiasis

Commonly called gallstones, cholelithiasis develops over years to decades in most people. Gallstones can range in size from a few millimeters to several centimeters. There can be one to a few to dozens. About 80 percent of gallstones contain mostly cholesterol; bile pigments such as BILIRUBIN make up the remainder. Many people have gallstones without symptoms. Gallstones become a health concern when they lodge in the bile ducts or when they cause irritation and inflammation of the gallbladder’s mucosal lining. In a variation of cholelithiasis, called choledocholithiasis, the gallstones form in the bile ducts.

Cholecystitis

Inflammation or INFECTION of the gallbladder most commonly occurs in conjunction with gallstones that block the flow of bile out of the gallbladder, though it can develop in biliary dyskinesia when the bile in the gallbladder stagnates. This stagnation irritates and inflames the lining of the gallbladder. Cholecystitis that occurs without gallstones is acalculus cholecystitis.

Gallbladder Disease and Weight Loss

These weight-loss efforts increase the risk for gallbladder disease:

  • rapid weight loss (3 pounds a week or greater)
  • BARIATRIC SURGERY (gastric banding, stapling, bypass)
  • weight loss cycling (cycles of loss and regaining weight, especially large amounts)

Symptoms of Gallbladder Disease and Diagnostic Path

PAIN is the primary symptom of gallbladder disease, and is characteristically:

  • steady, sometimes intense pain between the right rib cage and shoulder blade felt in the front, back, or both
  • brought on by eating fatty foods, often occurring several hours after eating
  • common at night, waking one from sleep
  • one to five hours in duration
  • not relieved by changing positions or taking over-the-counter pain medications

Other symptoms of gallbladder disease include NAUSEA, VOMITING, gastrointestinal distress (gas, bloating, DIARRHEA) not relieved by ANTACIDS, and light-colored stools that contain noticeable mucus. When a gallstone blocks a bile duct there often is JAUNDICE (yellowish discoloration of the SKIN) and severe tenderness over the site of the blockage. FEVER, chills, and unrelenting pain may signal an infection in the gallbladder. These circumstances require immediate medical attention.

The doctor’s physical examination includes a careful history of symptoms as well as palpation of the abdomen. The diagnostic path typically includes ULTRASOUND of the upper right abdomen, which can detect gallstones as small as 2 millimeters about the size of a thick pencil lead. It also can show thickening of the gallbladder’s wall, an indication of chronic inflammation and previous gallstone development. Because the liver shadows the gallbladder, ultrasound does not always detect inflammation related to acute cholecystitis or certain other gallbladder problems. Contrast dye XRAY (oral or intravenous) and radioisotope imaging (cholescintigraphy) provide detailed information about gallbladder function.

Gallbladder Disease Treatment Options and Outlook

Mild and infrequent symptoms may require no intervention beyond watchful waiting and lifestyle modifications such as eating a diet lower in fat, getting daily physical exercise, and WEIGHT LOSS AND WEIGHT MANAGEMENT. ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) often is successful in removing small gallstones from the bile ducts.

Surgery to remove the gallbladder (CHOLECYSTECTOMY) is the treatment of choice for acute, recurrent, or chronic cholecystitis and cholelithiasis in which gallstones cause pain and bile duct obstruction. There are two methods for performing cholecystectomy: laparoscopic surgery and OPEN SURGERY. About 95 percent of cholecystectomies performed in the United States are laparoscopic.

Medications to dissolve gallstones are not very successful and can cause significant side effects. Current treatment guidelines recommend these medications only when surgery is not a viable option. The two drugs doctors sometimes use are ursodiol (Actigall) and chenodiol (Chenix). Though EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL) is effective in breaking up KIDNEY stones, it so far has not proven to be successful in doing the same with gallstones.

About a third of people who have one gallbladder episode, such as a gallstone that causes pain, never have another. The gallbladder is an organ that, though useful, the body does not require. Most people make a full recovery from gallbladder surgery and can resume their normal activities without modification. No dietary restrictions or medications are necessary.

Risk Factors and Preventive Measures

Women are twice as likely as men to develop gallbladder disease. Researchers believe this increased risk correlates to the presence of ESTROGENS, which play an integral role in cholesterol METABOLISM. Women who are pregnant or taking oral contraceptives (birth control pills), which increase the body’s level of estrogen, are at highest risk. Gallbladder disease seldom occurs in children.

These factors increase the risk for gallbladder disease in men and women alike:

  • OBESITY
  • rapid weight loss or weight cycling
  • DIABETES
  • taking lipid-lowering medications
  • age 60 or older

Lifestyle habits such as nutritious diet and regular physical exercise minimize the likelihood of gallbladder disease. Dietary fiber helps absorb cholesterol from consumed foods, reducing the amount of cholesterol that becomes available in the bloodstream and for the liver to process.

See also DIET AND HEALTH; ENDOSCOPY; HYPERLIPIDEMIA; LIFESTYLE AND HEALTH; MINIMALLY INVASIVE SURGERY; PRIMARY BILIARY CIRRHOSIS; PRIMARY SCLEROSING CHOLANGITIS.

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