Diseases of the gallbladder include gallstones (hard stones that form in the gallbladder from cholesterol) and gallbladder dysfunction (gallbladder does not work properly). In general, treatment for most gallbladder diseases is to surgically remove the gallbladder. This is typically done with laparoscopic surgery.
Introduction to your gallbladder
The gallbladder is a small, pear-shaped organ that sits under your liver in the right upper side of your abdomen. The gallbladder is a small storage vessel for bile. Bile is a greenish liquid that is made in the liver, and it is stored in the gallbladder. When you eat a meal, your gallbladder squeezes out the bile to help digest and break down your food, particularly fat.
Anatomy of the gallbladder
The gallbladder (shown in green) is a small, pear-shaped organ that is tucked under the liver. It stores bile, a fluid that is made in the liver and helps the body break down fat. When you eat a meal that has fat in it, your gallbladder empties the bile into a tube called the "bile duct." The bile duct carries the bile into the small intestine to help with digestion.
Reproduced with permission from: Zakko SF. Patient Information: Gallstones (Beyond the Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.
Gallstones are small crystal-like stones that form inside the gallbladder, usually from cholesterol deposits. They come in many sizes, shapes, colors, and chemical composition. They can be as small as grains of sand or gravel (called "gallbladder sludge") or as big as the entire gallbladder, which can be up to 6 inches long.
About 10-20% of the U.S. population will have gallstones at some point in their lifetime. Many people can have stones for years without causing any symptoms. In other people, gallstones can cause symptoms when they move around and irritate the inside of the gallbladder, or when then become stuck and block the outlet of the gallbladder (called the cystic duct), or they move out of the gallbladder and block the tubes (called ducts) that connect the gallbladder to the liver and the intestines (called the common bile duct).
Gallstones can cause serious complications
- Infection of the gallbladder (called Cholecystitis)
- Gallbladder ruptures, which can lead to severe infection and death
- Jaundice (yellowing of the skin and eyes) due to blockage of the ducts that drain the liver (called the common bile duct)
- Pancreatitis (inflammation of the pancreas) due to blockage of the common bile duct which shares a drainage system with the pancreas
Symptoms of gallstones
In many cases, gallstones do not cause any symptoms. When they do cause symptoms, gallstones can cause:
- Abdominal pain – often on the right side just under the rib cage or across top portion of the abdomen; this pain is usually after a large or fatty meal
- Pain in the back or right shoulder, or between the shoulder blades
- Nausea and vomiting
- Fever, usually associated with abdominal pain
If you know that you have gallstones but have no symptoms, you probably will not need treatment. But if you start having symptoms, you should get treated. The symptoms can come and go, but they often get worse over time, and can cause serious complications as above.
Testing for gallstones
The most common test for gallstones is an ultrasound of the abdomen. An ultrasound is a painless test done in the radiology department. An ultrasound technician will perform the study, using a small plastic wand, and gently moves it around your upper abdomen, creating a picture of the organs inside using sound waves.
Even if tests show that you have gallstones, that does not mean they are causing symptoms. Your doctor might need to do other tests to make sure your stones and your symptoms are related. Many other conditions of the digestive system have similar symptoms as those caused by gallstones.
Treatment for gallstones
- For people without symptoms - The best option is no treatment. The stones generally will not go away, and symptoms may develop at a later time, and treatment can be considered if they start having symptoms.
- For People with symptoms - The most common treatment is surgery to remove the gallbladder and the stones (Called Cholecystectomy) and is one of the most common surgeries performed in the United States. It is, however, still major surgery involving anesthesia and has risks associated with it, just like any other surgery. The surgery does not affect digestion very much. But about half the people who have surgery have mild symptoms afterward, including watery bowel movements, gas, or bloating. These symptoms usually get better a few months after surgery. People who have their gallbladder removed do not need to worry about gallstones coming back.
There is a way to get rid of the gallstones with medication. However this usually takes months to years to work, and may not work for people with severe symptoms or complications from gallstones. Generally the stones will come back when the medication is stopped. This is not a routine treatment option.
For patients that have complications of gallstones, such as the gallstones are obstructing the bile ducts (causing jaundice) or the pancreatic ducts (causing pancreatitis), a special procedure called an ERCP may need to be performed to remove the stones from these ducts.
Other ways to prevent problems with gallstones
- Keep yourself at a healthy weight, obesity is big contributing factor to gallbladder problems
- Rapid weight loss can also cause gallstones (such as after pregnancy)
- Eat at least 3 meals per day with a little bit of fat to keep your gallbladder working (but avoid meals high in fat as this can worsen symptoms)
- Eat a balanced diet with fruits, vegetables, low-fat dairy products, and fiber
Learn more about gallstones.
Biliary dyskinesia is a disease of the gallbladder, but without gallstones, which causes “gallbladder dysfunction.” When you eat a meal, normally your gallbladder contracts (squeezes down), to push the bile into your intestines, which helps to break down your food. In patients with “biliary dyskinesia,” the gallbladder is not able to squeeze properly, and this can cause discomfort and pain after eating.
The symptoms are similar to those of people with gallstones: pain in upper abdomen, especially after eating fatty or large meals, and nausea or vomiting (see gallstones above). Patients will usually have an ultrasound test to look for gallstones, because they have similar symptoms, but it does not show gallstones.
Your doctor will likely order a test called a HIDA scan, with an ejection fraction. As an ultrasound looks at the structure of the gallbladder, specifically looking for gallstones or polyps, a HIDA scan looks at the function of the gallbladder (does the gallbladder work properly?). This is done in the radiology department. You will be given a medication, through an IV line, that causes your gallbladder to squeeze, similar to how it should when you eat a meal. This tests the ability of your gallbladder to squeeze (this is called the ejection fraction), and can diagnose “gallbladder dysfunction” or “biliary dyskinesia.”
Biliary dyskinesia can be a reason to remove the gallbladder, because it can cause symptoms. However, your doctor will likely want to do other tests, as well, to look at your stomach, intestines, liver, or other organs in the area that can be causing your symptoms, before removing your gallbladder. The doctor does not want to put you through a surgery that may not treat you symptoms, if the symptoms are caused from something other than your gallbladder.
Cholecystectomy is the medical term for surgery to remove the gallbladder. It is one of the most common surgeries performed in the U.S. It can be done as Laparoscopic or Open surgery.
This means the surgeon uses a “laparoscope,” a long, thin tube that has a light and a tiny camera on the end to see inside the body. (The laparoscope is sometimes called a “scope” for short.) The camera on the scope sends pictures of the inside of the body to a TV screen. When doing this type of surgery, the surgeon makes a small incision—usually one in the belly button—just big enough for the scope to fit through. Then the surgeon inflates the belly with carbon dioxide gas to lift up the skin and muscle and make everything inside easier to see. Next the surgeon makes 3 smaller incisions that narrow tools can fit through. These tools include clamps, scissors, and surgical clips or staples, which the surgeon can control from outside the body. While looking at the picture on the screen, the surgeon uses those tools to do the operation.
Most gallbladder removals in the US are done using laparoscopic surgery, but sometimes open surgery is necessary because the gallbladder and bile duct are too infected or scarred to do laparoscopic surgery safely, without risk of injury to surrounding organs, particularly the common bile duct which is a very important tube that connects the liver and the intestines. Cholecystectomy is routinely started with the laparoscope, and during the surgery the doctor may decide to change to an “open” surgery if the surgery cannot be done safely with the laparoscope.
This means the surgeon makes a much larger incision in your abdomen, under the Right side ribs, big enough to do the surgery directly. This is generally more painful, and requires a longer hospital stay, but sometimes is necessary to do the surgery safely.
Reasons for cholecystectomy (gallbladder removal)
Symptomatic gallstones. Gallstones are small stones that form inside the gallbladder. These stones can block the ducts that bile flows through. The stones can cause inflammation, pain, and other serious complications such as infection, jaundice, and pancreatitis (See Gallstones above). Removal of the gallbladder will prevent further complications and serious conditions from the gallstones.
Gallbladder polyps (small benign growths on the inside of the gallbladder); these can act like stones as they can block the opening of the gallbladder.
“Gallbladder dysfunction”, which means that the gallbladder does not work correctly (called Biliary Dyskinesia). This can also cause abdominal pain, and symptoms similar to gallstones.
Cancer of the gallbladder, which is rare but can occur. If gallbladder cancer is the reason for the surgery, it usually involves removing a small part of the liver next to the gallbladder, as well as the gallbladder.
Risks of cholecystectomy (gallbladder removal)
The risks of the surgery are low, but they can include:
Recovery after Cholecystectomy
- Damage to the ducts near the gallbladder and the liver that carry bile from the liver to the intestines (this is called the Common Bile Duct and is a very important structure).
- Bile leak after surgery, may require further procedures
- Damage to the bowels or other surrounding organs
- Need for further surgery or other procedures, such as ERCP or drain placement.
Recovery is a little different depending on whether you have laparoscopic or open surgery.
If you have laparoscopic surgery, you will probably be able to leave the hospital the same day you have surgery. But there is some chance you will need to stay overnight, especially if your gallbladder is inflamed. Even though the cuts on the outside are small, the operation inside is still a major surgery. Your doctor will want you to rest and avoid heavy lifting, sports, and swimming for at least 2 weeks. You should expect to have some pain at the incisions for several days, and you may need to be off work for 1-2 weeks. You will be given a prescription for pain medication to take at home.
If you have open surgery, you will probably stay in the hospital 2-5 days. While there, do your best to start walking as soon as possible. Also, do the breathing exercises that your nurse recommends. This is to prevent complications after surgery such as pneumonia and blood clots. After you go home, you should be able to do most of your normal activities, but you should avoid heavy lifting, sports, and swimming for a few weeks. You should expect to be off work (or school) for 2-4 weeks.
If you are taking narcotic pain medicine during recovery, you might get constipated. Take a stool softener or a laxative to prevent this problem.
If you develop any the following symptoms in the weeks after surgery, call your doctor:
- Fever or chills
- Redness or swelling around the cuts from your surgery (a little bit of redness, about ¼ inch around the wounds, is expected due to inflammation)
- Severe or cramping abdominal pain, or worsening abdominal pain
- Yellow skin or eyes, or dark colored urine, or pale (white-gray) bowel movements
- Nausea or vomiting (some nausea/ vomiting can be associated with anesthesia and pain medications, and should resolve in 24-48 hrs)
How will not having a gallbladder affect me?
The gallbladder has a purpose, but the body can be without it. The gallbladder stores bile that is made by the liver, and then squeezes it into the intestines when you eat to help digest your meal. Without your gallbladder, the liver makes the same amount of bile, but it trickles into the intestines continuously rather than being stored for use when you eat.
The surgery does not affect digestion very much. Most people are able to resume a completely normal diet 1-2 weeks after surgery. But about half the people who have surgery have mild symptoms afterward, including loose bowel movements (diarrhea) gas, or bloating, especially after eating a fatty meal. These symptoms usually get better a few months after surgery.
Gallbladder surgery does not cause weight loss; in fact, some people may gain weight after gallbladder surgery because they no longer have pain after eating.
Learn more about cholecystectomy.