Gallbladder problems are fairly common. I have found throughout my years as a gastroenterologist that nearly everyone has someone in their family who has had a gallbladder concern at some point. The numbers back up my observation: According to the National Institute of Diabetes and Digestive and Kidney Diseases, gallstones affect approximately 10 -15% of the U.S. population.
The gallbladder is one of those organs we probably don’t think much about—until something goes wrong. Gallbladder problems can be fairly minor and require no treatment, or they can be more severe and require surgery. The good news is that we can live without a gallbladder.
What is the Gallbladder
The gallbladder is a pear-shaped sac located under the liver. The liver produces bile, a light brown fluid that helps break down fats in food so they are absorbed into the bloodstream. The liver sends bile to the gallbladder, which acts as a storage reservoir. When we eat, the gallbladder contracts and empties bile into the small intestine where fats are digested and absorbed.
Gallstones, or cholelithiasis, are solid deposits of bile that form in the gallbladder. Gallstones can be as small as a grain of salt or as large as a golf ball. When people develop gallstones, they may have a single stone or many. Gallstones can lead to clogging of the bile ducts, impeding their ability to drain bile from the gallbladder and liver.
In most cases, people with gallstones have no symptoms. People without symptoms usually don’t need treatment. Those with symptoms feel pain in the upper right portion of the abdomen, under the rib cage. The pain can radiate to the back or right shoulder. The pain can last several minutes or many hours. It’s a sustained pain, rather than a brief shooting pain. This is called biliary colic. Sometimes, biliary colic can be accompanied by nausea and vomiting. When gallstones become symptomatic surgical removal of the gallbladder is most often necessary.
Gallstones are more likely to develop the older we get. Females are at higher risk than males of developing gallstones, particularly if they have had a child or are obese.
The best way to prevent gallstones is to maintain a healthy weight; we have found that people who are overweight are more likely to develop gallstones. A healthy diet full of fiber, fruits, vegetables and whole grains can help reduce risk. That said, losing weight too quickly can also lead to gallstones. If you are trying to lose weight, aim to lose about 1 to 2 pounds a week. Anything more than that can precipitate gallstones to develop.
An Inflamed Gallbladder
When gallstones completely clog the gallbladder, preventing it from emptying bile, the gallbladder becomes infected and inflamed. This condition is known as cholecystitis. When patients suffer from cholecystitis, the pain is more persistent than what may be experienced with gallstones alone. The pain progressively worsens. Other telltale signs include persistent vomiting and fever.
Treatment almost always includes hospitalization and surgical removal of the gallbladder. During the hospitalization, patients are given IV antibiotics and pain medicine. They also fast, giving the gallbladder an opportunity to rest. Once the inflammation subsides, the gallbladder is usually removed to prevent recurrent problems.
Bile Duct Stones
Another gallbladder-related issue we see is bile duct stones, usually occurring when gallstones migrate out of the gallbladder and into the bile ducts. The bile duct carries bile from the liver and gallbladder to the intestines. Gallstones are generally confined to the gallbladder, but 10- 15% of people with gallstones have them in both the gallbladder and bile duct.
Symptoms of bile duct stones include severe abdominal pain, nausea, vomiting, fever and jaundice, which is the yellowing of the skin. Bile duct stones can lead to pancreatitis, which is inflammation of the pancreas.
The main way we treat bile duct stones is through endoscopic retrograde cholangiopancreatography, or ERCP. This is a minimally invasive procedure in which we pass an endoscope through the mouth and down the throat, past the stomach and to the opening of the bile ducts. This procedure allows us to find the bile duct stones and remove them. In some cases, gallbladder removal surgery also is necessary.
When gallstones and other gallbladder-related issues cause symptoms, surgery is often needed. Gallbladder removal—or a cholecystectomy—is a fairly common procedure, done under general anesthesia. Laparoscopic gallbladder surgery involves several small incisions in the abdomen and is usually an outpatient procedure.
In some cases, however, this approach isn’t possible and more extensive, open surgery is required. Patients who have significant gallbladder scarring, severe inflammation or extensive bleeding often require open surgery.
Most people can lead a normal life without a gallbladder. Instead of bile being stored in the gallbladder, it will be released into the small intestine. Some may have some mild symptoms after gallbladder surgery, including loose stools, gas and bloating. Those without a gallbladder are encouraged to eat a balanced healthy diet.
If you have symptoms that you think may be connected to your gallbladder, reach out to your primary care physician or gastroenterologist for a consultation. Though gallbladder problems are inconvenient and often painful, most are treatable and the prognosis is very good.
Ali Fazel, MD, is a board-certified gastroenterologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Falls Church Medical Center. He also provides care through video and phone visits.