Top 5 Signs and Symptoms of Gallbladder Problems

March 29, 2023






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What is the Gallbladder?

What is Gallbladder Disease?

Common Gallbladder Problems

Gallstones

How to Know if You Have Gallstones

Gallbladder Inflammation

Gallbladder Polyps

Biliary Colic

Top 5 Symptoms of Gallbladder Disease

Nausea or Vomiting

Fever or Chills

Chronic diarrhea/Unusual stools or urine

Jaundice

When to See a Doctor

Diagnosis & Treatment

Pain, Symptoms, Problems, and More

Pain is the most common symptom of a gallbladder problem. It can be mild and intermittent or quite severe and frequent. It may begin to radiate to other areas of the body, including the back and chest.

This pain will often be accompanied by other symptoms. Read on to learn more about the gallbladder and how to identify a problem.

Your gallbladder is a 4-inch, pear-shaped organ. It’s positioned under your liver in the upper-right section of your abdomen.

The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in your intestine. The gallbladder delivers bile into the small intestine. This allows fat-soluble vitamins and nutrients to be more easily absorbed into the bloodstream.

Gallbladder conditions share similar symptoms. These include:

• Pain. It usually occurs in the mid to upper-right section of your abdomen.
• Nausea or vomiting. Chronic gallbladder disease may cause digestive problems, such as acid reflux and gas.
• Fever or chills. This may be a sign of infection and should be treated immediately.
• Chronic diarrhea. Defined as more than four bowel movements per day for at least 3 months.
• Jaundice. Marked by yellow-tinted skin, it may be a sign of a block or stone in the common bile duct.
• Stool abnormality. Lighter-colored stools is a possible sign of a common bile duct block.
• Discolored urine. Dark urine is a potential sign of a common bile duct block.

Any disease that affects your gallbladder is considered a gallbladder disease. The following conditions are all gallbladder diseases.

• Inflammation of the gallbladder. This is called cholecystitis. It can be either acute (short term), or chronic (long term).
• Common bile duct infection. An infection may develop if the common bile duct is obstructed.
• Gallbladder polyps. These are abnormal tissue growths that may be benign. Larger polyps may need to be surgically removed before they develop into cancer or cause other problems.
• Porcelain gallbladder. This is when calcium deposits stiffen the gallbladder walls and make them rigid.
• Gallbladder cancer. Although rare, if not detected and treated, this cancer can spread quickly.
• Gallstones. These are small, hardened deposits that form in the gallbladder. They can cause acute cholecystitis. More on gallstones and their complications below.

Gallstones are small, hardened deposits that form in the gallbladder. These deposits can develop and go undetected for years.

In fact, many people have gallstones and aren’t aware of them. They eventually cause problems, including inflammation, infection, and pain.

Other gallbladder problems or complications related to gallstones include:

• common bile duct stones
• abscess of the gallbladder
• gallstone ileus
• perforated gallbladder

Gallstones are usually very small, no more than a few millimeters wide. However, they can grow to several centimeters. Some people develop only one gallstone, while others develop several. As the gallstones grow in size, they can begin to block the channels that lead out of the gallbladder.

Most gallstones are formed from cholesterol found in the gallbladder’s bile. Another type of gallstone, a pigment stone, is formed from calcium bilirubinate. Calcium bilirubinate is a chemical that’s produced when the body breaks down red blood cells. This type of stone is rarer.

Explore this interactive 3-D diagram to learn more about the gallbladder and gallstones.

Common bile duct stones (choledocholithiasis)

When gallstones occur in the common bile duct, it’s known as choledocholithiasis. Bile is ejected from the gallbladder, passed through small tubes, and deposited in the common bile duct. It then enters the small intestine.

In most cases, common bile duct stones are actually gallstones that developed in the gallbladder and then passed into the bile duct. This type of stone is called a secondary common bile duct stone, or secondary stone.

Sometimes stones form in the common bile duct itself. These stones are called primary common bile duct stones, or primary stones. This rare type of stone is more likely to cause an infection than a secondary stone.

Abscess of the gallbladder

A small percentage of people with gallstones may also develop pus in the gallbladder. This condition is called empyema.

Pus is a combination of white blood cells, bacteria, and dead tissue. The development of pus, also known as an abscess, leads to severe abdominal pain. If empyema isn’t diagnosed and treated, it can become life threatening as the infection spreads to other parts of the body.

Gallstone ileus

A gallstone may travel into the intestine and block it. This condition, known as gallstone ileus, is rare but can be fatal. It’s most common among individuals who are over 65 years old.

Perforated gallbladder

If you wait too long to seek treatment, gallstones can lead to a perforated gallbladder. This is a life threatening condition. If the tear isn’t detected, a dangerous, widespread abdominal infection may develop.

Gallstones don’t cause every type of gallbladder problem. Gallbladder disease without stones, also called acalculous gallbladder disease, can occur. In this case, you may experience symptoms commonly associated with gallstones without actually having stones.

First, your doctor will talk with you about your medical history, symptoms, and family history. A physical exam is performed to locate pain in the abdomen. Your doctor may also ask about your diet and nutrition before doing a blood test.

Results from a blood test may indicate whether there’s an infection or inflammation in the gallbladder, bile ducts, pancreas, or even the liver.

Imaging tests are typically used to identify gallstones in your gallbladder. There are several types of image tests:

• Ultrasound. This test is considered the best imaging test for finding gallstones. Often doctors find “silent,” or gallstones that do not cause symptoms in this image test.
• Computed tomography (CT) scan. This combination of X-rays and technology can show gallstones as well as reveal complications such as blockage of the gallbladder or bile ducts.
• Magnetic resonance imaging (MRI). This test shows detailed images of your body’s organs and can show gallstones in your biliary tract ducts.
• Cholescintigraphy. Taking pictures of the biliary tract, this image scan can show gallbladder abnormalities and blockages in the bile ducts.
• Endoscopic retrograde cholangiopancreatography (ERCP). This more invasive procedure is often used to address an existing problem, such as a gallstone stuck in the common bile duct.

Once your doctor has performed any necessary tests, they can then try to make a diagnosis, followed by a recommended course of treatment.

If your doctor discovers gallstones in your gallbladder, you might have gallbladder removal surgery. Although gallbladder removal surgery is safe, there are always risks with any surgery. It’s important to speak openly with your doctor about:

• the surgery
• typical recovery
• potential complications

Following removal of your gallbladder via surgery, it’s possible you may develop an infection. Pain, swelling and redness, along with pus at the incision may require antibiotics.

Bile leakage is extremely rare — only 1 percent of people who have gallbladder removal surgery experience this complication.

Injuries to the bile duct, intestine, bowel, or blood vessels are other possible complications that may require additional surgery to fix.

Gallbladder removal surgery isn’t the only way to treat a gallbladder problem. Depending on your issue and diagnosis, treatment may include:

• over-the-counter (OTC) pain relievers, such as ibuprofen (Aleve, Motrin)
• lithotripsy, a procedure that uses shock waves to break apart gallstones and other masses
• oral dissolution therapy, though it does not have a high success rate
• surgery to remove gallstones

Not all cases will require medical treatment. You may also be able to find pain relief with natural remedies, such as exercise and a heated compress.

If you’re experiencing gallbladder problems, you may find it beneficial to adjust your diet. In addition, if you have gallbladder removal surgery, your doctor may advise dietary changes both before (pre-op) and after surgery (post-op).

Foods that may aggravate gallbladder disease include:

• foods high in trans fats and other unhealthy fats
• highly processed foods
• refined carbohydrates, such as white bread and sugar

Instead, try to build your diet around:

• fiber-rich fruits and vegetables
• calcium-rich foods, such as low fat dairy and dark leafy greens
• foods containing vitamin C, such as berries
• plant-based protein, such as tofu, beans, and lentils
• healthy fats, such as nuts and fish
• coffee, which reduces your risk of gallstones and other gallbladder diseases

Symptoms of a gallbladder problem may come and go. However, you’re more likely to develop a gallbladder problem if you’ve had one before.

While gallbladder problems are rarely deadly, they should still be treated. You can prevent gallbladder problems from worsening if you take action and see a doctor. Symptoms that should prompt you to seek immediate medical attention include:

• abdominal pain that lasts at least 5 hours
• jaundice
• pale stools
• sweating, low-grade fever, or chills, if they’re accompanied by the above symptoms

The most common indication that you may be experiencing a problem with your gallbladder is pain in the mid to upper-right section of your abdomen.

Gallstones may be responsible for the pain, and depending on the severity of your symptoms, your doctor may recommend gallbladder removal surgery if imaging tests reveal the presence of these small, hardened deposits.

symptoms, causes, treatment, opinion of a gastroenterologist

What is bile stasis?

Stagnation of bile , also known as cholestasis, is a condition in which the formation and / or outflow of bile is impaired. In other words, this is not a separate disease, but a set of changes (in the patient’s well-being, in his analyzes and instrumental examinations), which occur in many different pathologies.

How does bile stasis manifest itself?

The main symptoms that will make you suspect bile stasis are:

• Skin itching that gets worse in the evening and during warm showers
• Yellowing of the mucous membranes, sclera, and later on the skin
• Darkening of urine
• Light (sometimes almost white) feces
• Heaviness, discomfort in the right hypochondrium
• General weakness, malaise

With prolonged existence of bile stasis (cholestasis that persists for more than 6 months is called chronic), the absorption of fats and fat-soluble vitamins is impaired, which can be manifested by a decrease in visual acuity at dusk, increased bleeding, bone pain and a tendency to fracture, the appearance of xanthoma on the skin.

It should be noted that the severity of this or that symptom depends on various indicators of the state of the liver. So, for example, the higher the level of bilirubin in the blood, the brighter the yellow color of the mucous membranes and skin, and the intensity of itching correlates with the concentration of bile acids in the blood (therefore, itching can be observed even with the normalization of “standard” liver indicators). Heaviness and discomfort in the right hypochondrium can be replaced by severe pain, accompanied by nausea, vomiting, and even fever, if cholestasis is caused by blockage of the biliary tract with a stone from the gallbladder. And sometimes significant changes in laboratory parameters do not affect the patient’s well-being, and bile stasis is an accidental “find” when performing blood tests for other reasons (for example, before a planned operation).

In other words, the severity of the disease should be assessed by a combination of clinical (symptoms), laboratory (blood tests) and instrumental (ultrasound and other) data. And although in most cases the appearance of symptoms indicates the presence of a new acute situation or a worsening of the course of a chronic one, it is important to remember that the absence of complaints is not a guarantee of the normalization of the liver condition.

Possible causes of bile stasis

There are many reasons for the development of bile stasis, and sometimes even an experienced specialist takes a lot of time to make a correct diagnosis. This is due to the fact that bile from the moment of its formation to entering the intestine goes a long way and a problem (the cause of stagnation) can occur at any stage of this path.

Bile is formed by liver cells, from where it enters the interlobular and then larger bile ducts through the bile capillaries, which ultimately unite into the left and right, and then into the common hepatic duct. Below the “hepatic” duct merges with the so-called “cystic” duct (leads to the gallbladder) and passes into the “common bile” duct (aka common bile duct). This common bile duct carries bile from the liver and gallbladder into the duodenum.

Bile stasis can occur in any part of the described path: from the liver cell itself to the place where the common bile duct enters the intestine. It is conventionally accepted to divide the possible causes of cholestasis into 2 large groups: intrahepatic (respectively, the reason lies in the organ itself, before the exit of the bile ducts from the liver) and extrahepatic .

The most common intrahepatic causes of bile stasis are:

• Drug-induced liver disease
• Viral hepatitis
• Alcoholic hepatitis
• Cirrhosis of the liver (any origin)
• Primary biliary cholangitis
• Primary sclerosing cholangitis
• Many others (genetic disorders, Caroli syndrome, cystic fibrosis, tumor metastases, hematological diseases, etc.)

Extrahepatic causes include:

• Cholelithiasis (impaired outflow of bile due to obstruction of the common bile duct by a stone or due to the formation of a stricture (“infection”) in it with frequent traumatization by stones)
• Tumors or large cysts that compress the bile ducts externally (eg, cancer of the head of the pancreas)
• Tumors of the bile ducts (eg cholangiocarcinoma)
• Others (eg, occlusion of extrahepatic bile ducts in primary sclerosing cholangitis)

Thus, it will most likely not be possible to deal with the cause of skin itching and yellowing of the skin on your own, and in case of symptoms of bile stasis, you need to consult a doctor (generalist or gastroenterologist, in some cases you may need to consult an infectious disease specialist). If the situation arose acutely (suddenly), accompanied by an increase in body temperature, severe pain in the right hypochondrium, vomiting, a general deterioration in well-being, it is necessary to call an ambulance.

What examination should be done before visiting a doctor?

A large number of causes may require a long and complex investigation, including, in some cases, a liver biopsy. Blood tests for specific autoimmune antibodies, endoscopic ultrasound (endo-ultrasound or EUS), or magnetic resonance cholangiopancreatography (MRCP) may be required. However, at the initial stage of diagnosis, there are a number of indicators that will help your doctor navigate in determining the further vector of the examination.

If you suspect bile stasis, before visiting a doctor we recommend that you undergo the following minimal examination :

• Clinical blood test * – will help to suspect an infectious or hematological cause of bile stasis
• Alkaline phosphatase ( ALP* ), gamma-glutamyl transpeptidase ( GGTP* ), bilirubin and fractions* – main laboratory parameters of bile stasis
• Alanine aminotransferase ( ALT* ), aspartate aminotransferase ( AST* ) – two main indicators of liver cell damage
• Viral hepatitis markers: hepatitis B ( HBsAg ), hepatitis C ( anti-HCV ), in acute situations – hepatitis A ( anti-HAV IgM* ), for pregnant women – hepatitis E ( anti-HEV IgM* –
• Abdominal ultrasonography – to rule out “obvious” causes such as gallstones or large tumors

* Important! It is necessary to pass these examinations already after the onset of symptoms. If you donated blood a month ago, and your eyes turned yellow only today, a blood test a month ago will not be very informative .

Treatment of bile stasis

Treatment can be conditionally divided into two vectors. The first is the elimination of the cause that caused cholestasis, the second is the elimination of the consequences.

At the same time, extrahepatic causes, as a rule, require surgical intervention in the form of a “traditional” operation or endoscopic manipulation – endoscopic retrograde cholangiopancreatography (ERCP), while the elimination of intrahepatic causes consists in prescribing drug therapy (antiviral drugs, hormones, cytostatics and others).

Hepatoprotectors are mainly used to treat the consequences. The choice of a specific drug, its dose, duration of treatment and route of administration (tablets or intravenous / intramuscular) depend on the diagnosis, the nature and severity of changes in the tests, the presence or absence of contraindications to the drug. Treatment of pruritus associated with bile stasis, in some cases, may require the appointment of additional medications.

Independent attempts to get rid of bile stasis, especially by such “aggressive” methods as tubage, can not only not give a positive effect (for example, with autoimmune or genetic causes of cholestasis), but also lead to serious complications. So, for example, if there are small stones in the gallbladder, active attempts to “drive bile” will lead to the fact that these stones, “like in a water park”, will begin to descend through the bile ducts. This can cause blockage of the ducts and a complete cessation of the outflow of bile (i.e. aggravation of cholestasis), with the development of biliary colic or even an acute condition requiring surgical treatment.

Thus, both the diagnosis and treatment of bile stasis can become a difficult and rather lengthy process, which often cannot be handled without medical education and certain clinical experience. We strongly recommend that you do not self-medicate and, if bile stasis is suspected, consult a doctor to clarify the causes and select the optimal therapy.

In our center you can use the convenient HepatoChek-up program, which includes all the necessary minimum diagnosis of bile stasis (except for acute viral hepatitis A and E), as well as a number of additional laboratory parameters and liver elastography to exclude liver elastography to exclude cirrhosis.

For more information on how to treat bile stasis, see the video:

Bile stasis: causes, consequences and nutrition

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Perhaps everyone is familiar with the state when you eat a piece of fatty food and bitterness appears in your mouth, a feeling of heaviness in your right side, nausea – what does this mean? Such symptoms often indicate stagnation of bile.

How to deal with cholestasis, what to do with stagnation of bile, how to prevent the development of complications from a pathological condition? The gastroenterologist at St. Nicholas Clinic will tell you about this and much more!

Basic functions of bile and gallbladder

Bile is a secretion product of hepatocytes (liver cells) necessary for digestion of fats, proper assimilation of proteins, carbohydrates, fat-soluble vitamins. If bile is produced in the liver, then what is the gallbladder and why is it needed? From the liver, through special ducts, the secret enters the gallbladder – a small pear-shaped organ located next to the liver. From there, through the bile duct, bile enters the duodenum, where it directly implements its tasks.

If for some reason bile does not enter the intestines, accumulates and stagnates in the gallbladder, this leads to a violation of all the above processes.

Why is bile stasis dangerous?

First you need to understand what is bile stasis? This is a pathological condition in which bile is not excreted at all, or is evacuated from the bladder in insufficient volume.

By itself, bile is a highly concentrated secret containing many active ingredients. If it is in a stationary state for a long time, it thickens (it becomes viscous, jelly-like), bile components precipitate and contribute to the formation of stones. What does the gall bladder do? It reacts with inflammation – bile has an irritating effect on the walls of the bladder, provoking the development of cholecystitis.

Meanwhile, the liver cells continue to produce bile, it accumulates in the bladder and stretches the organ. Part of the secret due to increased pressure is thrown back through the hepatic ducts, having a toxic effect on the liver. This can lead to the development of toxic hepatitis and even cirrhosis of the liver.

As mentioned above, bile plays a very important role in the digestion of food. Violation of the absorption of fats and fat-soluble vitamins leads to an imbalance in metabolism, resulting in the development of beriberi, osteoporosis, dysbacteriosis. The growth of fats in the bloodstream leads to an increase in cholesterol levels, which is fraught with the development of atherosclerosis of blood vessels, heart disease.

Causes of bile stasis and its symptoms

The most common causes of the disease are: 14

Signs of cholestasis can be very diverse and they differ depending on the neglect of the process. Main symptoms:

1. Pain. Sensations can be either minor (discomfort, pulling / aching pain) or acute (sharp, strong, stabbing, paroxysmal pain in the right hypochondrium).
2. Bitterness in the mouth, frequent heartburn, belching, bad breath.
3. Signs of deficiency of fat-soluble vitamins – brittle bones, dry hair and skin, brittle nails.
4. In advanced cases – yellowness of the skin and mucous membranes, itching of the skin, dark urine, discoloration of the feces.
5. Dyspeptic symptoms – nausea, vomiting, bloating.
6. Weight loss.
7. Chronic fatigue, drowsiness, irritability.

Suspected signs of stagnation of bile – what to do? The first step is to immediately contact a specialist! Only a doctor can correctly diagnose, diagnose and choose the right treatment.

What foods should be avoided

Along with the examination by the doctor and the selection of treatment, it is important to take care of proper nutrition. Normalizing the nature of nutrition is the easiest and most effective way to get rid of stagnation of bile and prevent a relapse of the process.

First of all, you should give up bad habits – drinking alcohol, smoking. For patients with bile stasis, a special regimen has been developed – diet number 5. It excludes fatty, spicy, fried foods, flour products, and foods containing oxalic acid. It is also important to limit the amount of salt consumed to 10g/day. From fatty meat and fish, carbonated drinks, smoked meats, legumes will also have to be abandoned.

We figured out what foods it is desirable to exclude from the diet. And what is useful for the normal functioning of the gallbladder?

• Fractional nature of nutrition – you need to eat 5-6 times a day in small portions
• Eat low-fat meals, preferably steamed or baked
• Healthy fats (unsaturated fatty acids) – olive/linseed oil, fiber, fruits and vegetables
• Give preference to fish and lean meats
• Stay hydrated – it is important to drink enough water to thin bile

Methods for treating bile stasis

The choice of method and course of therapy depends on the stage of the disease, the cause of the stagnation, the presence of complications and concomitant diseases.