Gallbladder Diseases: Symptoms, Diagnosis, and Treatment Methods

The human digestive system consists of two main parts: the organs within the digestive tract and the accessory digestive organs. The digestive tract—comprising the mouth, esophagus, stomach, small intestine, large intestine, and anus—plays a major role in digestion. For effective mechanical and chemical digestion of food, absorption of nutrients in the small intestine, calorie supply for cells, and elimination of waste through defecation, both the organs of the digestive tract and accessory structures such as the liver, pancreas, and gallbladder must work together in harmony.

The gallbladder, in particular, stores bile produced by the liver and releases it into the small intestine to aid in the digestion of fats. Disruptions in gallbladder function can lead to various diseases, commonly resulting in pain, inflammation, or blockage. Recognizing the symptoms of gallbladder disease, obtaining a timely diagnosis, and following suitable treatment methods are crucial for maintaining digestive health and preventing complications.

What is the Gallbladder and What Does It Do?

The gallbladder, an accessory digestive organ, is a pear-shaped sac measuring about 10 cm in length with a capacity of 30-50 ml. It stores bile—a digestive fluid produced by the liver—and releases it into the duodenum (the upper part of the small intestine) through the common bile duct after eating. Bile’s main function is to break down fats in the small intestine into smaller particles, making it easier for digestive enzymes to further break them down, aiding in digestion. When diseases of the gallbladder prevent bile from being released into the small intestine, fat digestion becomes challenging, leading to various digestive problems such as constipation, intestinal blockages, and absorption disorders.

Where is the Gallbladder Located?

The gallbladder, responsible for storing bile produced in the liver and releasing it into the small intestine, is attached to the underside of the liver. It is situated in the mid-right section of the abdomen, approximately five fingers below the right nipple. Consequently, pain and tenderness in this area can be a sign of a gallbladder disorder.

Gallbladder Diseases

Gallbladder diseases are significant health issues that directly or indirectly impact the functioning of the digestive system. Major gallbladder-related diseases include:

• Cholelithiasis (Gallstones): Gallstones typically form due to high cholesterol levels and reduced gallbladder motility. Excess cholesterol accumulates in the bile, forming stone-like structures. The presence of stones in the gallbladder complicates bile storage and reduces bile flow into the intestines.
• Choledocholithiasis (Bile Duct Stones): Stones formed in the gallbladder can move with bile flow into the common bile duct, causing a condition known as choledocholithiasis.
• Acute or Chronic Cholecystitis (Gallbladder Inflammation): Stones in the gallbladder often lead to infection, resulting in cholecystitis, or inflammation of the gallbladder. Without prompt treatment, acute cholecystitis can lead to circulation issues in the gallbladder, pus accumulation (empyema), and even perforation of the gallbladder wall.
• Cholangitis (Bacterial Infection of the Bile Ducts): A bacterial infection in the bile ducts is a critical condition. If not detected and treated in its early stages, cholangitis can lead to severe sepsis and potentially result in fatal complications.
• Gallstone Ileus: A gallstone can travel through the common bile duct and into the small intestine, causing an obstruction known as gallstone ileus.
• Mirizzi Syndrome: In this condition, a large gallstone lodges at the beginning of the common bile duct, causing blockage. Without effective treatment, Mirizzi syndrome can lead to chronic inflammation, tissue damage in the ducts that affect the liver, and abnormal duct formation.
• Porcelain Gallbladder: Calcium in the bile may deposit on the gallbladder wall, forming a hardened layer. This condition, which resembles porcelain in appearance, typically results from chronic gallbladder inflammation.
• Biliary Dyskinesia (Gallbladder Dysfunction): In biliary dyskinesia, or gallbladder dysfunction, the gallbladder’s movements slow down, preventing complete bile release. Although the exact cause is unknown, it may be related to chronic gallbladder inflammation.

Gallbladder Cancer

Gallbladder cancers are rare but often have a poor prognosis because they are typically detected at advanced stages. Untreated gallstones and the resulting chronic gallbladder inflammation can lead to gallbladder cancer. Therefore, it is essential to have accurate information about gallbladder diseases and their symptoms.

Symptoms of Gallbladder Diseases

Symptoms of gallbladder diseases are generally related to the digestive system; however, some diseases may remain asymptomatic for many years. It is important to recognize all potential symptoms and signs in order to detect gallbladder diseases early.

• Pain: The first symptom in conditions like gallstones and gallbladder inflammation is pain in the upper right quadrant of the abdomen. In particular, gallstones and cholecystitis caused by stones can result in pain radiating to the right shoulder blade, especially worsening after heavy meals, leading to recurrent abdominal pain attacks known as biliary colic.
• Nausea, Vomiting: Nausea, vomiting, abdominal bloating, and excessive gas are symptoms often associated with gallbladder diseases. If there is an obstruction preventing bile from entering the small intestine, digestive issues like nausea, bloating, and constipation, especially after consuming fatty foods, may become more frequent.
• Jaundice: Diseases that cause bile duct obstruction significantly affect liver function, leading to a yellowish tint in the skin and the whites of the eyes, known as jaundice. This symptom is critical for detecting conditions like Mirizzi syndrome.
• Fever: Infectious conditions like gallbladder inflammation may cause high fever with chills. Persistent pain in the upper right abdomen along with fever should raise suspicion of inflammatory gallbladder diseases.

Diagnosis and Treatment Methods for Gallbladder Diseases

Gallbladder diseases are often asymptomatic and may go undetected for years. However, if one or more indicative symptoms appear, various imaging methods are used for diagnosis. Many gallbladder diseases impact liver function directly or indirectly, so liver function tests are conducted initially. Elevated levels of liver enzymes such as ALT, AST, GGT, and ALP in the blood, along with symptoms like abdominal pain, fever, and jaundice, are typically sufficient for diagnosis. In some cases, additional imaging techniques like abdominal X-rays, ultrasound, and computed tomography (CT) scans may be necessary.

The most common treatment for gallbladder diseases is the surgical removal of the diseased gallbladder. For inflammatory gallbladder diseases, antibiotic therapy is needed before surgery. Once the infection is controlled with medical treatment, the gallbladder is typically removed via laparoscopic surgery. This minimally invasive procedure, performed through a few small incisions without a large abdominal opening, is one of the most advantageous treatment methods for many gallbladder-related diseases.