Gallbladder disease: symptoms, treatment, and management

An estimated 20 million people in the US have gallbladder disease. The incidence  increases with age and is more prevalent in women than in men.

The best way to address the symptoms of gallstones and gallbladder disease is by taking the time to learn more about your gallbladder health. This comprehensive guide is an overview of gallbladder diseases, types, symptoms, treatments, and tips to maintaining a healthy gallbladder.

What is a gallbladder?

The gallbladder is a sac-like and pear-shaped organ located under the liver. The  gallbladder stores bile, and when a person eats a meal, the gallbladder deflates and releases the bile into the intestine for active absorption of fats.

What is gallbladder disease?

Gallbladder disease is commonly prevalent in developed countries. It involves  chronic inflammation within the walls, stones formation, cholesterol, and other lipid  depositions, eventually leading to a gallbladder blockage.

Types of gallbladder disease

1. Gallstones (Cholelithiasis)

Gallstones are one of the most common problems in the western world. Among  those who experience gallstones, only 20% tend to suffer from biliary or gallstone colic  (pain associated with gallstones migration).

Gallstones involve the formation of cholesterol and solidified bile pigments containing  calcium bilirubinate and calcium salts. These stones increase in size and become  trapped in the ducts. Gallstones are usually asymptomatic; however, in some cases, the migration of these stones causes biliary colic (pain), which radiates from the right  lower ribs to the back and may rarely spread to the right shoulder blade.

2. Cholecystitis

The inflammation of the gallbladder is called cholecystitis. It can be acute or chronic.  Acute cholecystitis may require surgical intervention.

 Acute Cholecystitis

Around 90% of the acute cholecystitis cases involve gallstones blockage inside the  cystic duct resulting in swelling and an inflamed gallbladder. The remaining 10% is due to the recent childbirth, previous surgery, dehydration, injuries, burns, diabetes  mellitus, or bacterial infection. It can cause severe and recurrent pain. A patient may  experience:

• Severe pain in the upper right abdomen
• Fever
• Nausea and vomiting
• Slight jaundice
• Abdomen swelling

Please get urgent medical attention in the case of acute cholecystitis. Call us now to  book an appointment.

Chronic Cholecystitis

The chronic cholecystitis is usually present with the gallstones. The reason for the  initiation of the inflammatory response is still vague. In some cases, the recurrent  attacks of dull acute cholecystitis may cause chronic cholecystitis.

The symptoms are not adequately defined. A patient with this condition may experience:

• Epigastric discomfort after a meal
• Dull pain in the upper right abdomen
• Nausea and vomiting.

3. Cancer of Gallbladder

It is a rare type of cancer; according to the CDC, it is more prevalent among women  than men (ratio 4:1). It usually occurs in the 7^th decade of life. The carcinoma is often diagnosed at a later stage when it becomes inoperable. Gallbladder carcinoma symptoms are similar to gallbladder disease.

4. Gallbladder polyps

Gallbladder polyps are the abnormal tissue growth on the inner lining of the mucosa of the gallbladder. It’s rare for a polyp to become cancerous. An estimated 5%-10% of polyps are likely to become cancerous, while most polyps are benign.

In the case of a symptomatic malignant polyp, cholecystectomy may be performed.

5. Biliary Dyskinesia

It is a symptomatic motility disorder of the gallbladder when bile doesn’t properly drain out of the gallbladder.

A patient usually comes to the hospital or general practice with pain similar to that of biliary colic and can easily be diagnosed with ultrasound. If the ultrasound scan doesn’t show clear results, the HIDA scan is preferred. Cholecystectomy is the only available option to treat biliary dyskinesia.

6. Biliary Hyperkinesia

It is a motility disorder of the gallbladder. It involves the rapid contraction and emptying of the gallbladder. A patient with biliary Hyperkinesia will experience biliary related symptoms and will have more than 80% of gallbladder ejection fraction (CCK).

Usually, no gallbladder stones are observed in ultrasound imaging. Therefore CCK-HIDA scan is used to diagnose biliary hyperkinesis. The treatment is cholecystectomy.

What treatment options are available?

Depending on the severity of gallbladder disease and patients’ history, a doctor may  advise different treatment options on a case by case basis. For patients suffering  from the large gallstones, various calcium-containing gallstone stones, chronic  cholecystitis, and gallbladder cancer, a surgeon usually recommends removing the  gallbladder after ruling out other possible treatment regimens.

Gallbladder Removal Surgery

Your physician will aim to provide symptomatic treatment of the disease and reduce the inflammation inside the gallbladder. The initial steps involve:

1. May require to stop certain medications as per the surgeon’s advice. 2. Antibiotics preoperatively.
2. Fasting night before the surgery as directed by the doctor.
3. Intravenous fluid intake to minimize dehydration.

Gallbladder Removal Surgery Options

In America, around 500,000 patients undergo gallbladder removal surgery each year.

Keyhole surgery (laparoscopic cholecystectomy) or open surgery is performed for the removal of the gallbladder. The recovery takes place within a week for both surgeries.

Laparoscopic Cholecystectomy or Keyhole surgery remains the surgical choice for symptomatic and complicated gallstones. It involves general anesthesia and minimally invasive 3 to 4 small incisions in the abdomen.

Note: Laparoscopic cholecystectomy is generally a minimally invasive procedure. But in some circumstances, your surgeon may find it necessary to increase the incision size based on the complications involved.

Open surgery is the preferred modality for pregnant women and obese patients. It involves general anesthesia and a single incision, ~ 15 cm long.

The last step involves suturing the incision and aftercare for wound healing. The duration of both surgeries is anywhere from 30-90 minutes.

Extracorporeal shock wave lithotripsy:

It is a non-invasive procedure involving a series of shock waves to break down the stones into small pieces that can easily pass through the urinary tract and leave the body, given that the gallstones are small.

Non-surgical treatment

If calcium ions aren’t present in the stones, then a specialist generally recommends a healthy diet and NSAIDs for pain management. Suppose the pain and other symptoms recur and affect the daily life of a patient. In that case, a few non-surgical and surgical options are available to treat the gallstone disease depending on the severity.

1. Antibiotics and painkillers

To prevent the spread of infection, the doctor may prescribe antibiotics. NSAIDs if the patient is in pain.

2. Ursodeoxycholic acid treatment:

Ursodeoxycholic acid oral treatment involves taking a course of tablets for up to 2  years when the gallstones are small, and the stones don’t contain calcium ions. However, a person may develop gallstones again after discontinuation.

3. Oral dissolution therapy:

Doctors may recommend oral dissolution therapy and the ursodeoxycholic acid  treatment for patients with gallstones who have high cholesterol. It takes around 6-18 months for the treatment.

How to live a healthy life without a gallbladder?

Fortunately, you can live a perfectly healthy life without a  gallbladder. However, it’s still important to follow a balanced diet and to exercise regularly. After a cholecystectomy, the liver can still make enough bile to continuously drain into the intestine to digest and absorb fats.

Follow the diet plan advised by your doctor to avoid post-cholecystectomy  syndrome, which involves diarrhea, bloating, and fever. Luckily, you don’t need to  follow this for long as the complications may disappear within weeks.

Easy tips for maintaining a healthy gallbladder

Maintaining a healthy gallbladder is the same as maintaining a healthy diet. Eating a  healthy balanced diet, exercising regularly, and staying hydrated is key to keeping  your gallbladder healthy.

1. Take fiber-enriched fresh vegetables, fruits, beans, and nuts.
2. Eat a whole-grain diet such as oats, wheat bread, etc.
3. Eat healthy fat with low cholesterol, such as olive oil and fish oil.
4. Eat a plant-based diet containing a balanced amount of calcium, proteins,  Vitamin B9 (folate), and magnesium.
5. Exercise the right type of moves regularly that specifically promote the health  of the gallbladder.
6. Maintain a healthy weight within the normal BMI range.
7. Avoid refined carbohydrates–diets containing white flour and added sugars such as baked desserts, cakes, candies, and chocolates.
8. Avoid unhealthy fat-containing diets such as processed meat, fat-enriched  meat, sauces, fried food, other fast food, etc.
9. Quit smoking

10. Avoid quick weight loss or any weight loss surgery.

Dr. Dasari is a top gallbladder removal surgeon and physician specialist in Las Vegas and Henderson. He is affiliated with the Valley Health System, Dignity Health, Boulder City Hospital, and Valley View Surgery Center. If you are  experiencing symptoms of gallbladder disease or gallstones, call his henderson clinic to schedule a personalized evaluation.