The gallbladder is a sac located under the liver. It stores and concentrates bile produced in the liver. Bile aids in the digestion of fats, and is released from the gallbladder into the upper small intestine (duodenum) in response to food, especially fats.
Types of gallbladder disease include:
- Cholecystitis (inflammation of the gallbladder)
- Cholelithiasis (gallstones)
Symptoms of Gallstones
You can have gallstones without any symptoms. However, if the stones are large, they can block the duct that leads from the gallbladder. This can cause gallbladder pain and require treatment. At first they may block the duct and move away, causing only occasional gallbladder pain. Continuous blockage of the duct, however, can be life threatening and requires surgical removal of the gallbladder.
Symptoms may include:
- Pain, mostly on the upper right side of the abdomen
- Pain following meals, intolerance of fatty foods
- Nausea and vomiting
- Loss of appetite
What Causes a Gallbladder Attack?
A gallbladder attack usually happens because a stone is blocking a passageway in the gallbladder. Gallstones develop in the gallbladder when substances in bile form hard particles. They can be as small as a grain of sand or as large as a golf ball. Women are at higher risk of developing gallstones than men, and the risk increases the more children a woman has had.
Pregnancy is also a risk for gallstone formation. The increased risk associated with having children can be offset by breastfeeding. Women who use hormone replacement therapy are also at higher risk of developing gallstones. Being overweight and rapid weight loss followed by weight gain are other risk factors for gallstones. Having coronary artery disease is also associated with gallbladder disease.
Symptoms of Gallbladder Inflammation
Between 1 and 3% of people with symptomatic gallstones develop inflammation in the gallbladder (acute cholecystitis), which occurs when stones or sludge block the duct. The symptoms are similar to those of biliary colic, but are more persistent and severe. They include the following:
- Pain in the upper right abdomen that is severe and constant, and may last for days. Pain frequently increases when drawing a breath.
- Pain may also radiate to the back or occur under the shoulder blades or behind the breast bone.
- About a third of patients have fever and chills, which do not occur with uncomplicated biliary colic.
- Nausea and vomiting may occur.
Gallbladder Disease Treatment
Acute gallbladder pain from gallstones and gallbladder disease is usually treated in the hospital, where diagnostic procedures are performed to rule out other conditions and complications. There are three approaches to gallstone treatment:
- Expectant management ("wait and see")
- Nonsurgical removal of the stones
- Surgical removal of the gallbladder
The first step if there are signs of acute cholecystitis is to "rest" the gallbladder in order to reduce inflammation. This involves the following treatments:
- Fasting
- Intravenous fluids and oxygen therapy
- Strong painkillers, such as meperidine (Demerol). Potent NSAIDs, such as ketorolac, may also be particularly useful.
- Intravenous antibiotics. These are administered if the patient shows signs of infection, including fever or an elevated white blood cell count, or in patients without such signs who do not improve after 12 to 24 hours.
People with acute cholecystitis almost always need surgery to remove the gallbladder. The most common procedure now is laparoscopy, a less invasive technique than open cholecystectomy (which involves a wide abdominal incision). Surgery may be done within hours to weeks after the acute episode, depending on the severity of the condition.