What Is Gallbladder Disease?

Overview

The biliary duct system includes the liver, pancreas, and gallbladder. The gallbladder is an organ responsible for releasing and storing bile that is produced in the liver. Bile is crucial for digesting and absorbing fat from our diets. It is estimated that 80%¹ of patients will present with biliary colic, many with recurrent suffering for up to 10 years. Diagnosis of gallbladder disease is heavily based on symptoms, many of which are generic gastrointestinal flares, including upper right quadrant pain (biliary colic), fever, nausea, vomiting, and flatulence. Serious symptoms such as jaundice, increased white blood cells (leukocytosis), secondary infections, heart and blood complications (cardiovascular dysfunction), and pancreatitis can indicate more urgent complications.² Prevention and management of the conditions vary depending on the type of gallbladder disease you may have; many are easily resolved with simple lifestyle changes. However, removal of the gallbladder or blockages may be required in cases of gallstones or cholecystitis.

Causes of gallbladder disease

Gallstones are caused by a chemical imbalance and excess cholesterol. Gallstones can grow in both the gallbladder and the bile ducts of patients who are susceptible, mostly in people assigned female at birth (AFAB) over 40.

There are different types of stones that can develop in the gallbladder. Cholesterol gallstones make up more than 70%³ of gallstones and are composed mostly of cholesterol. In contrast, bilirubin gallstones are mostly made up of bilirubin, and mixed gallstones can be built from a mixture of cholesterol, bilirubin, calcium, and phosphates. 

Autoimmune cholangiopathies are immune-driven gallbladder diseases; these include primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). They are mostly caused by T cells. T lymphocytes build up at the site, which causes severe destruction of the organs and leads to fibrosis and cirrhosis in the case of PCB. PSC is a less common liver disease from chronic inflammation, and fibrosis and is usually associated with ulcerative colitis inflammatory bowel disease.⁴ 

Cholecystitis or acute acalculous cholecystitis (in the absence of gallstones) is an inflammatory condition caused by the walls of the gallbladder due to the build-up of gallstones. This obstructs the cystic duct, causing prolonged pain and inflammation. About 95% of cases are due to the presence of gallstones.⁵ Complicated and severe cholecystitis carries a significantly higher risk to patients assigned male at birth (AMAB).⁶  Comorbidities play a key role in gallbladder diseases, and underlying or known conditions make you more susceptible to developing stones and inflammation. These include diabetes, obesity, and medical conditions such as Crohn’s disease. 

• Diabetes is one of the most common diseases worldwide, affecting a range of people from all age groups. There are two main types of diabetes: Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM). T1DM is an autoimmune disease that leads to the body attacking its own pancreatic cells and destroying the body’s ability to produce insulin. T2DM is a condition developed over time that leads to the body developing its own resistance to insulin. It usually develops due to lifestyle choices like high sugar or alcohol consumption.⁷ Having diabetes puts you at a higher risk of complications that can affect all organs in the body, and T2DM is highly associated with obesity and gallstones.  

• Obesity increases the risk of gallbladder disease due to a combination of factors, whether environmental or genetic. Being clinically overweight is a risk factor for gallstones due to having a high sensitivity to chemicals⁸ and fats, such as C-reactive protein and excessive cholesterol.
• Crohn’s disease is greatly linked with gallbladder disease. Often, resections of the bowel are needed in the management of Crohn’s disease, and this causes chemical imbalances and an increase in cholesterol, regardless of weight and age.⁹ Crohn’s disease makes you twice as likely to develop gallstones. Although not fully understood, a disturbance in the bile cycle and reduced bile salts have been associated with patients with the disease¹⁰

Signs and symptoms of gallbladder disease

The most frequent and mild symptom of gallbladder disease is intermittent pain located in the upper right quadrant of the torso,¹¹ This is usually followed by nausea and biliary colic. Biliary colic is where gallstones block the bile duct, which causes pain behind the breastbone. Inflammation of the bladder is similar to that of biliary colic but presents more severely, with persistent pain that may go on for up to a week. Cholecystitis can be accompanied by fever and vomiting.

Management and treatment for gallbladder disease

Surgery is usually warranted in many cases, but management of the symptoms and conditions is the first priority for doctors. These first steps are initiated by meeting with your doctors and presenting your symptoms to identify the cause. You will usually have tests to identify and monitor things like your blood pressure, weight, and cholesterol. You may be given prescription drugs to clear any infections, and drugs may be given to break up any gallstones, especially if surgery is not recommended. 

Surgeries involved in treating gallbladder disease may include cholecystectomies, which is the total removal of the gallbladder. Most cholecystectomies are through keyhole surgery (laparoscopic surgery) as an outpatient. If you are young and develop gallstones, you will be highly likely to have future episodes, and surgery would be the sensible option in cases like these.

Non-surgical procedures include percutaneous removal, extracorporeal shock wave therapy (ESWT), and endoscopic retrograde cholangiopancreatography (ERCP).

Percutaneous removal is used for gallstone patients who cannot have surgery. A catheter is passed through the skin into the gallbladder to allow drainage of the fluid. Over time, the catheter is expanded until the hole is large enough to access the stone.

ESWT is also used for gallstones, after sedation, shockwaves are used to break the gallstones into small pieces. This procedure is used for patients with low weight and only a few stones.

ERCP is a non-surgical procedure for the removal of tumours, cysts, bile duct problems, and gallstones. An endoscope allows a more thorough investigation of the small intestine and stomach. Tumours are also treated with chemotherapy and radiotherapy.

Diagnosis

Diagnosis of gallbladder disease can be identified in many ways due to the variety of disorders it covers. The initial stage is determining inflammation of the gallbladder; your doctor may carry out Murphy’s sign test.¹² The Murphy’s sign test involves your doctor moving their hand across the abdomen and applying pressure when the patient takes a deep breath. This allows them to feel any swelling and witness any pain the patient may be in when pressure is applied to the gallbladder region.

Imaging tests are used to visualise stones, organs, and the surrounding soft tissue. 

Magnetic resonance imaging (MRI), computer tomography (CT) scans, and ultrasounds are all regularly used equipment in hospitals because they are painless, safe, and do not usually require sedation. Other imaging techniques may involve safe, radioactive dyes to view how an organ is working, such as 

Laboratory tests can detect infections and increased chemicals by examining your blood and urine. Specific tests to identify problems with your organs include liver function tests, bilirubin and alkaline phosphatase (bile ducts), amylase and lipase tests (pancreas), and a complete blood count (gallbladder).

FAQs

How can I prevent gallbladder disease?

Gallbladder disease can be prevented by eating a healthy diet. This could include foods with fibre (e.g., fruits, vegetables, legumes, and whole grains), eating fewer fats and refined carbohydrates, and avoiding fried food. 

How common is gallbladder disease?

Gallbladder disease affects up to 15% of the population.

Who is at risk of gallbladder disease?

People who are overweight and consume a high-fat and low-fibre diet are at a much greater risk of developing gallbladder disease. Comorbidities and immune disorders also play a key role in the development of many gastric disorders. People who are in the 5 Fs categories are also at a higher risk. 

What are the 5 Fs of gallbladder disease?

The 5 Fs of gallbladder disease are a reminder for patients with upper abdominal pain whether they might be at a greater risk of gallstones (cholelithiasis).

• Were you assigned female at birth?
• Are you overweight (fat)? 
• Are you forty or over? 
• Do you have fair skin?
• Are you in a fertile stage of life? 

When should I see a doctor?

At the onset of any symptom that is abnormal to you, your first point of call should be to arrange an appointment with your physician, especially if you are included in the 5 Fs categories.

Summary

The gallbladder is an organ that aids in the digestive process, releasing bile that allows the breakdown and absorption of fat from our diets. The most common gallbladder disease is gallstones, which are made mostly from cholesterol. The population most affected are those within the 5 Fs categories, those with comorbidities such as obesity and diabetes, and digestive disorders such as Crohn’s disease. Diagnosis and management of gallbladder disease are symptom-driven; this can include monitoring your diet, weight, and cholesterol, as well as physical examination of your abdomen. You may need imaging scans to determine the presence of gallstones or to observe the structure and function of the afflicted organs. There are surgical and non-surgical pathways in the treatment of gallbladder disease; in most cases, physicians will opt for the least intrusive method on a case-to-case basis. Lifestyle changes are key aspects for a speedy recovery and a reduction in repeat disorders.