Gallbladder disease includes inflammation, infection, stones, or obstruction of the gallbladder. The gallbladder’s only purpose is to store bile (a fluid made by the liver to help digest fats in the small intestine).
The gallbladder is a small pear-shaped sac located under the liver. It stores and concentrates bile fluid produced in the liver.
Bile fluid aids in the digestion of fats, and is released from the gallbladder into the upper small intestine (duodenum) in response to food (especially fats). Conditions that slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease.
Types of Gallbladder Disease
Cholelithiasis is the presence of one or more gallstones in the gallbladder. Bile can become concentrated and thicken, and eventually, the bile salts can combine with cholesterol to form gallstones.
About 90% of gallstones cause no symptoms. There is a very small (2%) chance of developing pain (called biliary colic) during the first 10 years after gallstones form. After 10 years, the chance for developing symptoms declines. The mildest and most common symptom of gallbladder disease is intermittent pain called biliary *colic, which occurs either in the mid- or upper-right portion of the upper abdomen.
Choledocholithiasis is the presence of a gallstone in the common bile duct and can occur even in people who have had their gallbladder removed.
Acute cholecystitis is a sudden inflammation of the gallbladder that produces severe abdominal pain. 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, Acute cholecystitis is caused by a gallstone becoming jammed either in the junction of the gallbladder and cyctic duct or in the common duct.
The inflammation and subsequent pain of acute cholecystitis is usually caused at first by the chemicals in the bile and then by a bacterial infection that develops in 50% or more of cases. This process usually resolves on its own in several months, but not always!
Acute cholecystitis affects about twenty percent of those who develop gallbladder symptoms, most frequently women between the ages of twenty and forty, and is associated with past episodes of intermittent pain which occurs either in the mid- or the right portion of the upper abdomen. This pain is called binary colic, and is associated with indigestion and often prominent flatulence. The pain begins suddenly, is severe and constant, and is felt across the right and central parts of the upper abdomen and under the right shoulder blade. Symptoms usually include vomiting and fever. If the common bile duct becomes swollen, slight jaundice (yellowing of the skin and eyes) may occur as bile from the liver is shunted into the bloodstream.
Acute Cholecystitis and Gallbladder Perforation
If the infection becomes extensive, then the acute cholecystitis can become complicated and the gallbladder can rupture, a condition called localized perforation of the gallbladder.
Chronic gallbladder disease (chronic cholecystitis) involves gallstones and mild, long-lasting inflammation of the gallbladder or the recurrent attack of pain caused by a stone becoming stuck either in the junction of the gallbladder and the bile duct or in the duct itself. The muscle in the wall of both the gallbladder and bile duct contracts in an effort to move the stone and this produces intense pain usually felt under the ribs on the right side of the abdomen, and often extends across the abdomen and spreadsaround to the back to below the right shoulder blade. It can cause vomiting and restless, and after several hours, the stone either falls back into the gallbladder or the stone is passed down the bile duct and into the intestine. In such cases the gallbladder may become scarred and stiff causing some people to suffer from a constant dull ache in the upper abdomen and discomfort and flatulence after eating a fatty meal.
Gallbladder carcinoma is uncommon, but it still is far more frequent than is generally realized and may manifest with the same symptoms as acute or chronic cholecystitis, with which it is commonly confused. If some one with symptoms of cholecyctitis has abnormal liver function tests, and their CT scan demonstrates a small gallbladder with focal gallbladder wall thickening, and enlarged regional lymph node, then gallbladder carcinoma should be suspected.
Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Acute cholangitis is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with a tumor or stricture.
The classic triad of cholangitis symptoms is called Charcot’s triad: Right upper Quadrant pain, Jaundice and Fever. The classic four symptoms is called Reynod’s pentad: Charoct’s triad + hypotension and mental status change (coma, anxiety or delirium)
Primary Sclerosing Cholangitis (PSC)
Primary sclerosing cholangitis (PSC) is a chronic, usually progressive, liver disease that is thought to be due to an autoimmune process that scars and consticts the lumen of the of the biliary tree. The resulting scarring of the bile ducts blocks the flow of bile from the liver to the small intestine, causing it to back up (a condition called cholestasis). The strictures in the ducts of the biliary tree are located in both the liver (intrahepatic) and outside of the liver (extrhepatic) in more than 80% of people with primary sclerosing cholangitis. About 10% of these people with primary sclerosing cholangitis have strictures limited to the liver, while only less than 5% will have only extrhepatic strictures.
The majority of patients with primary sclerosing cholangitis have underlying inflammatory bowel disease, namely ulcerative colitis or Crohn’s disease. Patients with primary sclerosing cholangitis are more likely to have ulcerative colitis than Crohn’s disease (85% versus 15%), with approximately 2.5–7.5% of all ulcerative colitis patients having primary sclerosing cholangitis.
Most patients with primary sclerosing cholangitis have no symptoms; however, when symptoms develop they are a result of obstruction to the flow of bile and include jaundice (yellowing of the skin), itching, right upper quadrant abdominal pain, fever, and chills. Symptoms may also include weight loss and fatigue, and the development development of symptoms usually suggests the presence of advanced disease. Remissions and relapses characterize the course of primary sclerosing cholangitis.
Sclerosing cholangitis refers to swelling (inflammation), scarring, and destruction of the bile ducts inside and outside of the liver.
Chronic Acalculous Gallbladder Disease
Chronic acalculous gallbladder disease is the condition in which the natural movements needed to empty the gallbladder do not work well. People with this chronic acalculous gallbladder disease condition have significant symptoms of gallbladder disease without having gallstones.
There are three subtypes of chronic acalculous gallbladder disease:
1) Mild chronic cholecystitis
2) Hyperplastic cholecystoses (abnormalities of the gall bladder that cause enlargement of the gall bladder that is not due to inflammation).
3) Bile duct obstruction from kinking or external bands.
Congenital Gallbladder Defects
Congenital defects of the gallbladder that are present at birth.
Polyps growths of tissue (polyps) in the gallbladder.
Gallstone pancreatitis is caused when a gallstone obstructs the outflow of the pancreas.