Gallbladder Problems: Everything You Need To Know

Most of us don't give much thought to our gallbladders—until they become painfully plugged up.

Your gallbladder is like a little storage sac: It sits under your liver, collecting bile until the liquid is needed to help break down fats. After you eat fatty foods, your gallbladder contracts to pump bile into your small intestine for digestion.

William Silverman, MD, Professor Emeritus of Internal Medicine - Gastroenterology and Hepatology at University of Iowa Health Care, told Health that when people develop a problem in this pear-shaped organ, it's typically one of two things: "Gallstones, which are incredibly common, or gallbladder cancer, which is exceedingly rare."

Read on to learn more about both.

What Exactly Are Gallstones?

Gallstones form when substances in bile harden. The pebble-like lumps can form when there's an imbalance of substances in the bile. Gallstone attacks usually happen after you eat.

More than 25 million Americans have them—but most never even know it.

When gallstones block the bile ducts of your biliary tract (which is made up of your gallbladder and bile ducts), the gallstones can cause sudden pain in your upper right abdomen. This pain is called a gallbladder attack, or biliary colic. If left untreated, gallstones can cause serious complications.

The Role of Female Hormones

Females are more likely than males to develop gallstones.

Specifically people who have extra estrogen in their body due to pregnancy, hormone replacement therapy, or birth control pills may be more likely to produce gallstones.

"During pregnancy you secrete the hormone progesterone in an increased amount and that decreases the gallbladder contraction," Dr. Silverman said. Bile lingering in the organ may become stagnant and stones may precipitate out.

Who Else Is at Risk?

Certain populations are predisposed to gallstones, Dr. Silverman said, including the Pima Indians in Arizona. But most cases aren't related to genetics, Dr. Silverman added.

You are more likely to develop gallstones if you have obesity, especially if you are a female, have had fast weight loss, such as from weight-loss surgery, or have been on a diet high in calories and refined carbohydrates and low in fiber.

You are also more likely to develop gallstones if you have one of the following health conditions:

  • Cirrhosis, a condition in which your liver slowly breaks down and stops working due to chronic, or long-lasting, injury
  • Hemolytic anemias, conditions in which red blood cells are continuously broken down, such as sickle cell anemia
  • Some intestinal diseases that affect normal absorption of nutrients, such as Crohn's disease
  • High triglyceride levels
  • Low HDL cholesterol
  • Metabolic syndrome, which can also raise the risk of gallstone complications
  • Diabetes and insulin resistance

The majority of people who get gallstones don't have any of the major known risk factors, Dr. Silverman said. "That would suggest that there are many things that we still really don't understand."

How Are Gallstones Treated?

Sometimes healthcare providers discover gallstones by accident while looking for something else. In that case, it's generally best to leave them alone.

But if you're experiencing symptoms, a healthcare provider will likely suggest cholecystectomy—an operation to remove the gallbladder (which may be done laparoscopically).

Fortunately, the organ isn't essential; once the gallbladder is gone, bile will flow directly from your liver to your small intestine.

Nonsurgical Options

A healthcare provider may use the following types of nonsurgical treatments to remove or break up cholesterol gallstones.

Endoscopic retrograde cholangiopancreatography (ERCP) can be used to remove a gallstone that is stuck in the common bile duct.

In oral dissolution therapy, ursodiol and chenodiol are medicines containing bile acids that can be used to break up gallstones. These medicines work best to break up small cholesterol stones and may require months or years of treatment to break up all stones.

Shock wave lithotripsy can be used to blast gallstones into small pieces. This procedure is used rarely, and sometimes along with ursodiol.

In the slides ahead you'll find the most common signs of a gallbladder problem.

Symptom: Pain in the Upper Right Abdomen

This is where your gallbladder is located, just beneath your liver. Sudden, extreme pain could mean that stones are causing a blockage: Your gallbladder may be contracting but unable to drain, "so pressure builds up and it hurts," Dr. Silverman said.

But there are many other reasons you might experience pain in this area, Dr. Silverman said, including muscle spasms. Call a healthcare provider for emergency advice.

Sudden, intensifying pain in your intestines—located in the center of your abdomen—could also be a sign of gallstones.

Symptom: Fever and Chills With Abdominal Pain

A blockage by gallstones can cause a buildup of bile in the gallbladder, which may lead to an infection called cholecystitis. Cholecystitis happens when a digestive juice called bile gets trapped in your gallbladder.

Pain, chills, and a fever of 100.4 degrees Fahrenheit or higher are classic symptoms and may come on after a big meal.

There are a variety of ways to detect the problem, including blood tests and a scan that tracks the flow of bile. If you're diagnosed, a healthcare provider will likely want to check you into the hospital.

The treatment might involve fasting, antibiotics, and pain meds until the inflammation subsides.

Symptom: A Change in the Color of Your Urine and Stools

Bile salts are what make stools brown. If you noticed that your number-twos are pale or clay-colored, that might indicate that a gallstone is blocking the bile duct.

Your urine can also provide a clue. When there is excess bile building up in the body, it can turn your pee a tea-colored.

Symptom: Yellowing of the Skin and Eyes

Jaundice is a condition that causes the skin and eyes to turn yellow. It can by a sign of gallstones, but when it's accompanied by abdominal pain and weight loss, it may be a symptom of gallbladder cancer.

If a tumor is blocking the flow of bile, the yellow-brown fluid may build up in the body and give the skin and the whites of the eyes a yellow tint.

Keep in mind, though, that jaundice is caused more often by hepatitis than cancer. In any case, it's a good idea to see a healthcare provider right away.

A Sign You May Need Your Gallbladder Removed

Gallbladder polyps are growths on the inside of the gallbladder wall. They show up on ultrasounds, often when healthcare providers are investigating unrelated problems.

Most of the time, they're nothing to worry about. But people with big polyps have a higher risk of developing gallbladder cancer, Dr. Silverman said.

"I would emphasize that these are very large polyps, not tiny ones," Dr. Silverman added.

As a preventative measure, a healthcare provider may recommend gallbladder removal.

What About Gallbladder Cancer?

People who have a history of gallstones or large polyps are more likely to develop gallbladder cancer—but even among this group, the risk is very small.

The American Cancer Society estimates there about 12,000 cases diagnosed per year.

Still, if you've dealt with gallbladder problems in the past and begin experiencing abdominal pain, bloating, itchiness, fever, nausea, or unexplained weight loss, then make an appointment with a healthcare provider.

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Sources
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  1. MedlinePlus. Gallbladder Diseases.

  2. MedlinePlus. Gallstones.

  3. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Gallstones.

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Gallstones.

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Gallstones.

  6. MedlinePlus. Acute cholecystitis.

  7. American Cancer Society. Signs and Symptoms of Bile Duct Cancer.

  8. Uptodate. Gallbladder polyps.

  9. American Cancer Society. Risk Factors for Gallbladder Cancer.

  10. American Cancer Society. Key Statistics for Gallbladder Cancer.

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