What is acute acalculous gallbladder disease. How does it differ from gallstone-related gallbladder problems. What are the symptoms of acute acalculous gallbladder disease. How is this condition diagnosed and treated. What complications can arise if left untreated.

What is Acute Acalculous Gallbladder Disease?

Acute acalculous gallbladder disease is a rare condition characterized by inflammation of the gallbladder without the presence of gallstones. While gallstones are the most common cause of gallbladder problems, affecting up to 25 million people in the United States, acute acalculous gallbladder disease occurs in less than 10% of inflamed gallbladder cases.

What distinguishes this condition from other gallbladder issues? Unlike cholecystitis, which is typically caused by gallstones in 90% of cases, acute acalculous gallbladder disease develops due to other factors, primarily severe infections affecting the entire body.

Who is at Risk for Acute Acalculous Gallbladder Disease?

Acute acalculous gallbladder disease typically affects patients who are already seriously ill from other causes. The primary risk factor for developing this condition is sepsis, a severe and potentially life-threatening systemic infection. During sepsis, bacteria circulate throughout the bloodstream and can eventually reach the gallbladder, leading to infection and inflammation of this organ.

Why does sepsis increase the risk of acute acalculous gallbladder disease? In sepsis, the body’s immune response to infection becomes dysregulated, potentially causing widespread inflammation and organ dysfunction. The gallbladder, being part of the digestive system, can become a target for bacterial invasion and subsequent inflammation during this process.

Other Risk Factors

• Prolonged fasting or total parenteral nutrition
• Major surgery or trauma
• Severe burns
• Prolonged mechanical ventilation
• Immunosuppression

Symptoms of Acute Acalculous Gallbladder Disease

The symptoms of acute acalculous gallbladder disease can be similar to those of other gallbladder problems. However, they often develop suddenly and can be quite severe. What are the key indicators of this condition?

1. Pain in the right upper abdominal area
2. Intermittent pain that comes and goes
3. Nausea accompanying the pain
4. Pain exacerbation after meals, especially those high in fat

How does the pain of acute acalculous gallbladder disease differ from other types of abdominal pain? The pain is typically localized to the right upper quadrant of the abdomen and may radiate to the right shoulder or back. It is often described as a constant, dull ache that can become sharp or cramping during acute episodes.

Diagnosis of Acute Acalculous Gallbladder Disease

Diagnosing acute acalculous gallbladder disease can be challenging due to its rarity and similarity to other gallbladder conditions. What steps do healthcare providers take to identify this condition?

The diagnostic process typically begins with a thorough medical history and physical examination. If gallbladder disease is suspected, an ultrasound is usually the first imaging test performed. In cases of acute acalculous gallbladder disease, the ultrasound may reveal a thickened and distended gallbladder wall without the presence of gallstones.

Additional Diagnostic Tests

• Blood tests to check for signs of infection and inflammation
• CT scan or MRI for more detailed imaging of the gallbladder and surrounding tissues
• HIDA scan to evaluate gallbladder function
• Endoscopic retrograde cholangiopancreatography (ERCP) in some cases

Treatment Options for Acute Acalculous Gallbladder Disease

The treatment of acute acalculous gallbladder disease focuses on addressing the underlying infection and managing symptoms. What are the primary treatment approaches for this condition?

Intravenous antibiotics are the cornerstone of treatment for acute acalculous gallbladder disease. These powerful medications are necessary to combat the severe infection that often underlies this condition. Oral antibiotics are typically not sufficient to address the severity of the infection.

In some cases, drainage of the gallbladder may be necessary. This procedure involves inserting a small drain into the gallbladder to allow infected bile to escape. Why is drainage sometimes required? Infected bile can exacerbate inflammation and potentially lead to more severe complications if not addressed.

When is Surgery Considered?

While surgery is rarely the first-line treatment for acute acalculous gallbladder disease, it may be considered in certain situations. When might a healthcare provider recommend gallbladder removal (cholecystectomy)?

• If antibiotic treatment and drainage are ineffective
• In cases of severe inflammation or perforation of the gallbladder
• When there is a high risk of complications

Potential Complications of Untreated Acute Acalculous Gallbladder Disease

Acute acalculous gallbladder disease can lead to serious complications if left untreated. What are the potential risks associated with this condition?

1. Complete blockage of the bile ducts
2. Perforation of the gallbladder
3. Gangrene of the gallbladder tissue
4. Sepsis or septic shock
5. Multiorgan failure

Why are these complications so serious? Bile duct blockage can lead to jaundice and potentially life-threatening infections. Gallbladder perforation can cause bile to leak into the abdominal cavity, leading to peritonitis. Gangrene represents dead tissue that can become a source of severe infection. Sepsis and multiorgan failure are critical conditions that can be fatal if not addressed promptly.

Preventing Acute Acalculous Gallbladder Disease

While it’s not always possible to prevent acute acalculous gallbladder disease, certain measures can reduce the risk, especially in critically ill patients. What strategies can help minimize the likelihood of developing this condition?

• Early mobilization of hospitalized patients when possible
• Proper nutrition and avoidance of prolonged fasting
• Prompt treatment of underlying infections
• Careful monitoring of critically ill patients for signs of gallbladder inflammation
• Management of risk factors such as diabetes and immunosuppression

How do these preventive measures work? Early mobilization helps maintain proper blood flow and reduces the risk of bile stasis in the gallbladder. Adequate nutrition supports overall health and immune function. Prompt treatment of infections can prevent their progression to sepsis, a major risk factor for acute acalculous gallbladder disease.

Long-term Outlook for Patients with Acute Acalculous Gallbladder Disease

The prognosis for patients with acute acalculous gallbladder disease can vary depending on several factors. What determines the long-term outlook for individuals affected by this condition?

The severity of the underlying illness, timely diagnosis and treatment, and the presence of complications all play crucial roles in determining outcomes. Patients who receive prompt and appropriate treatment generally have a good prognosis, with many recovering fully without long-term consequences.

Factors Influencing Prognosis

• Overall health status of the patient
• Severity of the initial infection or underlying condition
• Timeliness of diagnosis and treatment initiation
• Presence of complications such as perforation or gangrene
• Response to antibiotic therapy

What follow-up care is typically required after treatment for acute acalculous gallbladder disease? Patients often need ongoing monitoring to ensure complete resolution of the infection and to address any potential long-term effects on gallbladder function. In some cases, dietary modifications or additional treatments may be necessary to manage persistent symptoms or prevent recurrence.

Differentiating Acute Acalculous Gallbladder Disease from Other Gallbladder Conditions

Understanding the differences between acute acalculous gallbladder disease and other gallbladder conditions is crucial for accurate diagnosis and appropriate treatment. How does this condition compare to more common gallbladder problems?

Unlike gallstone-related cholecystitis, acute acalculous gallbladder disease occurs in the absence of gallstones. This key distinction affects both the diagnostic approach and treatment strategies. While gallstone-related issues often require surgery, acute acalculous gallbladder disease may be managed with antibiotics and supportive care in many cases.

Comparison with Other Gallbladder Conditions

What role does imaging play in differentiating these conditions? Ultrasound and other imaging techniques are crucial in identifying the presence or absence of gallstones, assessing gallbladder wall thickness, and evaluating for signs of inflammation or infection. These findings, combined with clinical symptoms and laboratory results, guide healthcare providers in making an accurate diagnosis.

Recent Advances in Understanding and Treating Acute Acalculous Gallbladder Disease

As medical research progresses, our understanding of acute acalculous gallbladder disease continues to evolve. What recent developments have enhanced our ability to diagnose and treat this condition?

Advancements in imaging technology, such as high-resolution ultrasound and contrast-enhanced CT scans, have improved the accuracy of diagnosis. These tools allow for better visualization of gallbladder wall changes and detection of subtle signs of inflammation, even in the absence of gallstones.

Emerging Treatment Approaches

• Novel antibiotic therapies targeting resistant bacteria
• Minimally invasive drainage techniques
• Immunomodulatory treatments for managing severe inflammation
• Targeted therapies addressing underlying risk factors

How might these advances impact patient care? Improved diagnostic accuracy can lead to earlier detection and treatment, potentially reducing the risk of complications. Novel treatment approaches may offer more effective options for managing acute acalculous gallbladder disease, particularly in cases resistant to conventional therapies.

The Role of Diet and Lifestyle in Gallbladder Health

While acute acalculous gallbladder disease is primarily associated with severe illness and infection, maintaining overall gallbladder health can play a role in reducing the risk of various gallbladder problems. What dietary and lifestyle factors can contribute to gallbladder health?

A balanced diet rich in fruits, vegetables, and whole grains can support overall digestive health, including gallbladder function. Maintaining a healthy weight and engaging in regular physical activity may also reduce the risk of gallbladder issues.

Dietary Recommendations for Gallbladder Health

• Limit intake of saturated and trans fats
• Include sources of healthy fats, such as olive oil and fatty fish
• Consume adequate fiber to support digestive function
• Stay hydrated to promote proper bile flow
• Consider including foods that support liver and gallbladder function, such as leafy greens and lean proteins

How do these dietary choices impact gallbladder health? A balanced diet can help maintain proper bile composition and flow, reducing the risk of bile stasis and potential inflammation. While these measures may not directly prevent acute acalculous gallbladder disease, they contribute to overall digestive health and may reduce the risk of other gallbladder conditions.

In conclusion, acute acalculous gallbladder disease represents a rare but potentially serious condition that requires prompt diagnosis and treatment. Understanding its causes, symptoms, and management strategies is crucial for healthcare providers and patients alike. By recognizing the signs of this condition and seeking timely medical attention, individuals can improve their chances of a positive outcome and prevent potentially life-threatening complications.

Gallbladder Problems Without Gallstones

Gallbladder problems are usually caused by gallstones. When they aren’t, a condition called acute acalculous gallbladder disease, an inflammation of the gallbladder, may be the culprit.

By Diana RodriguezMedically Reviewed by Pat F. Bass III, MD, MPH

Reviewed: January 25, 2010

Medically Reviewed

Although gallstones are the most common cause of gallbladder disease, they’re not always the culprit. Acute acalculous gallbladder disease is a big term for something pretty simple — it simply means gallbladder disease that isn’t caused by gallstones.

Gallbladder Problems: When It’s Not Gallstones

Acalculous gallbladder disease is really quite rare. Gallbladder problems are most often attributed to gallstones or a condition called cholecystitis — a type of gallbladder disease characterized by inflammation of the gallbladder. But cholecystitis is most often caused by gallstones — as often as 90 percent of the time.

That means that fewer than 10 percent of inflamed gallbladders occur for some other reason than gallstones. And although there are other problems that can occur with the gallbladder, these two are by far the most common — acalculous gallbladder disease occurs so rarely that there aren’t readily available statistics on it.

Acute acalculous gallbladder disease “typically happens in already sick patients from other causes,” says Tomasz Rogula, MD, PhD, a staff surgeon at the Bariatric and Metabolic Institute at the Cleveland Clinic in Ohio. Most often, these people are sick with a major infection called sepsis, which is a generalized infection of the whole body. The bacteria travel through the bloodstream and eventually travel to the gallbladder, infecting it and causing inflammation.

By comparison, gallstones are a rather common malady, striking more than 25 million people in the United States — as much as 10 percent to 15 percent of the entire population. At the greatest risk are women ages 20 to 60, as up to 20 percent of them will have gallstones.

Gallbladder Problems: Acute Acalculous Gallbladder Disease Symptoms

Acute acalculous gallbladder disease, which can cause the gallbladder to become thickened and distended, is characterized by a sudden inflammation of the gallbladder wall.

Symptoms include pain that:

• Is localized to the right upper abdominal area
• Comes and goes
• Is accompanied by nausea
• Strikes after a meal, particularly one including very fatty or greasy foods

Gallbladder Problems: Treating Acute Acalculous Gallbladder Disease

If a patient complains of pain characteristic of gallbladder disease, Dr. Rogula says that an ultrasound is usually performed to check for gallstones. If they are not present, a blood test can look for bacteria in the blood that can indicate acute acalculous gallbladder disease caused by infection.

The most common treatment for acute acalculous gallbladder disease, says Rogula, is intravenous administration of antibiotics — a pill won’t typically battle this raging infection.

“Sometimes we need to drain the bile that is inside the gallbladder because the bile can be infected as well,” he adds. A tiny drain is inserted inside the gallbladder, which allows the bile to escape. Gallbladder removal surgery is very rarely used to treat acute acalculous gallbladder disease, Rogula says, but might be considered if antibiotics and drainage aren’t effective in treating the condition.

Gallbladder Problems: If Acalculous Gallbladder Disease Goes Untreated

Acute acalculous gallbladder disease isn’t something to ignore, particularly if a serious septic infection is to blame.

“It can be very dangerous if not treated,” says Rogula. The condition can lead to:

• Complete blockage of the bile ducts
• A perforation — a small hole — in the gallbladder, which allows bile to leak outside the gallbladder
• Gangrene

If you’ve got suspicious pains in your upper right abdomen, it’s best to get it checked out — if it’s your gallbladder, gallstones are most likely to blame. But if they aren’t, your doctor will run tests to find out what’s troubling your gallbladder, and remedy the situation appropriately to ease your pain.

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Acute cholecystitis: MedlinePlus Medical Encyclopedia

Acute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.

The gallbladder is an organ that sits below the liver. It stores bile, which is produced in the liver. Your body uses bile to digest fats in the small intestine.

Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because a gallstone blocks the cystic duct, the tube through which bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.

Other causes include:

• Serious illnesses, such as HIV or diabetes
• Tumors of the gallbladder (rare)

Some people are more at risk for gallstones. Risk factors include:

• Being female
• Pregnancy
• Hormone therapy
• Older age
• Being Native American or Hispanic
• Obesity
• Losing or gaining weight rapidly
• Diabetes

Sometimes, the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to long-term (chronic) cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It does not store and release bile as well as it did.

The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel:

• Sharp, cramping, or dull pain
• Steady pain
• Pain that spreads to your back or below your right shoulder blade

Other symptoms that may occur include:

• Clay-colored stools
• Fever
• Nausea and vomiting
• Yellowing of skin and whites of the eyes (jaundice)

Your health care provider will perform a physical exam and ask about your symptoms. During the physical exam, you will likely have pain when the provider touches your belly.

Your provider may order the following blood tests:

• Amylase and lipase
• Bilirubin
• Complete blood count (CBC)
• Liver function tests

Imaging tests can show gallstones or inflammation. You may have one or more of these tests:

• Abdominal ultrasound
• Abdominal CT scan or MRI scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan

If you have severe belly pain, seek medical attention right away.

In the emergency room, you’ll be given fluids through a vein. You also may be given antibiotics to fight infection.

Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.

Nonsurgical treatment includes:

• Antibiotics you take at home to fight infection
• Low-fat diet (if you are able to eat)
• Pain medicines

You may need emergency surgery if you have complications such as:

• Gangrene (tissue death) of the gallbladder
• Perforation (a hole that forms in the wall of the gallbladder)
• Pancreatitis (inflamed pancreas)
• Persistent bile duct blockage
• Inflammation of the common bile duct

If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery.

Most people who have surgery to remove their gallbladder recover completely.

Untreated, cholecystitis may lead to any of the following health problems:

• Empyema (pus in the gallbladder)
• Gangrene
• Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
• Pancreatitis
• Perforation
• Peritonitis (inflammation of the lining of the abdomen)

Call your provider if you have:

• Severe belly pain that does not go away
• Symptoms of cholecystitis return

Removing the gallbladder and gallstones will prevent further attacks.

Cholecystitis – acute; Gallstones – acute cholecystitis

• Gallbladder removal – laparoscopic – discharge
• Gallbladder removal – open – discharge
• Gallstones – discharge

• Digestive system
• Cholecystitis, CT scan
• Cholecystitis – cholangiogram
• Cholecystolithiasis
• Gallstones, cholangiogram
• Gallbladder removal – Series

Glasgow RE. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 66.

Radkani P, Hawksworth J, Fishbein T. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 55.

Wang DQ-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.

Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Ultrasound of the gallbladder

Anatomy of the gallbladder and bile ducts

The gallbladder is located on the lower surface of the right lobe of the liver in a recess. It is usually pear-shaped or elliptical in shape. Distinguish the bottom, body and neck of the gallbladder. A normal gallbladder has a smooth smooth wall, which is clearly visible on ultrasound of the gallbladder and has a thickness of no more than 3 mm. The length of the gallbladder is normally up to 10 cm, width – up to 3 cm. The neck of the gallbladder passes into the duct of the gallbladder, which flows into the common hepatic duct. In turn, after the connection of the gallbladder duct and the common hepatic duct, the common bile duct is formed, which leaves the gate of the liver and goes in the thickness of the gastroduodenal ligament to the posterior wall of the horizontal part of the duodenum, and then enters the head of the pancreas, where it connects with the duct pancreas and opens through the papilla of Vater on the inner wall of the descending duodenum. The volume of the gallbladder of an adult reaches 30-50 ml. Sometimes during an ultrasound of the gallbladder, you can notice mucosal folds, which are the result of wrapping the wall of the gallbladder inward. These folds deform the gallbladder and may be mistaken for a polyp during an ultrasound of the gallbladder.

How is ultrasound of the gallbladder performed? Before the study, you can not drink strong tea and coffee, as well as smoke and chew chewing gum. Usually, ultrasound of the gallbladder is performed from different positions, and the patient is asked to change position – for example, lying on his back, on his left side, sitting. This makes it possible to assess the mobility of structures located inside the gallbladder. For example, gallbladder stones shift when the position of the patient’s body changes, and this serves as an additional diagnostic criterion. In cases where the patient has eaten heavily at night, the gallbladder may be contracted. Therefore, for ultrasound of the gallbladder, 30 minutes before the study, a fatty meal is used, which contributes to the separation of bile and filling the gallbladder.

Congenital anomalies on ultrasound of the gallbladder

Gallbladder agenesis – congenital absence of the gallbladder. This anomaly occurs in 0.01-0.04%. In this case, during an ultrasound of the gallbladder, the organ is not visualized. Diagnosis must be confirmed by other imaging modalities, but is best established intraoperatively (accidental finding during surgery).

Ectopic localization of the gallbladder – finding the gallbladder in an atypical location, for example, retroperitoneally, between the diaphragm and the right lobe.

Double gallbladder – occurs in 1 in 3000-4000 people.

Multiple septa of the gallbladder – can simulate a picture of acute cholecystitis and gallbladder polyposis.

Gallbladder diverticula – protrusions of the gallbladder wall.

Abnormalities in the size of the gallbladder – enlarged and reduced gallbladder. An enlarged gallbladder (more than 4 cm wide) can simulate a number of serious diseases with ultrasound of the gallbladder: acute cholecystitis, obstruction of the bile ducts. Reduced gallbladder (less than 2 cm after adequate starvation) – can simulate cholecystitis, viral hepatitis.

Ultrasound of the gallbladder in cholelithiasis

Gallbladder stones are observed in 10-15% of the population, causing secondary changes in the wall of the organ. Stone development increases with age and is associated with obesity, rapid weight loss, eating habits, and ethnicity. Gallbladder stones can also form during treatment with cephalosporin antibiotics. Once these drugs are stopped, these stones tend to resolve on their own. Most stones have a mixed structure consisting of cholesterol, calcium bilirubinate, and calcium carbonate. About 10% of stones are purely cholesterol. Calcium carbonate-only stones are rare. With ultrasound of the gallbladder, stones are easily identified. Stones can be with the so-called echo-shadow and without it. Echo – a shadow with ultrasound of the gallbladder occurs behind the stone, since the surface of the stone is impervious to ultrasound. The presence of an echo shadow is an additional criterion for the presence of a gallstone. In the event that the size of the stone is less than 3 mm, the echo-shadow on the ultrasound of the gallbladder may be absent. Ultrasound of the gallbladder can reveal floating stones – those that weigh less than bile and do not sink to the bottom point under the influence of gravity. Gallbladder stones can come in a variety of shapes and sizes. The exact number of stones during ultrasound of the gallbladder is not always possible to determine, since the acoustic shadow interferes.

Ultrasound gallbladder sludge

Gallbladder sludge or hyperechoic bile is the so-called “sediment” that forms when cholesterol crystals and bilirubin granules accumulate on the mucus produced by the gallbladder wall. Sludge usually occurs with prolonged fasting, with obstruction of the biliary tract, with hemolytic anemia. Usually, the fluid collects on the lower part of the gallbladder and moves with a change in the position of the patient’s body, which can be traced with an ultrasound of the gallbladder. In some cases, sludge can produce an acoustic shadow. In the case of conditions such as hemorrhage, accumulation of pus and inflammatoryly altered non-viable pieces of tissue with ultrasound of the gallbladder, it is impossible to distinguish them from sludge. Therefore, under such circumstances, they are guided by clinical manifestations.

Ultrasound of the gallbladder in acute cholecystitis

Acute cholecystitis – inflammation of the gallbladder. In 10-20% of cases, it complicates cholelithiasis. The mechanism of development of acute cholecystitis is not fully understood, but blockage of the bile ducts by stones and the attachment of infection are important. Ultrasound of the gallbladder in acute cholecystitis does not have clear symptoms. They always focus on the totality of phenomena detected during the ultrasound. In the majority (up to 70%) of patients with ultrasound of the gallbladder, a thickened wall is recorded. Also often there is a positive ultrasound Murphy’s symptom – pain when the probe is pressed on the gallbladder area. With ultrasound of the gallbladder, duplex scanning of the cystic artery is also used to diagnose acute cholecystitis. When the gallbladder becomes inflamed, blood flow through it increases. Considering the totality of symptoms during ultrasound of the gallbladder, the diagnostic accuracy of this study for suspected acute cholecystitis reaches 80%. To clarify the diagnosis resort to cholecystography. Nevertheless, ultrasound of the gallbladder remains the most optimal study in case of pain in the upper abdomen, since the cost of ultrasound is not as high as with other research methods and it is carried out quite quickly. In addition, with ultrasound of the gallbladder, it is possible to simultaneously diagnose adjacent organs. Ultrasound of the gallbladder can also diagnose complications of acute cholecystitis: gallbladder empyema, gangrenous cholecystitis, gallbladder perforation, hemorrhagic and emphysematous cholecystitis, and the formation of a biliary-intestinal fistula.

Ultrasound of the gallbladder in chronic cholecystitis

In chronic cholecystitis, the wall of the gallbladder thickens, its contours become indistinct. Sometimes small particles can be seen in the lumen that do not give an echo shadow. There are no pathognomonic (inherent only to this disease) signs of chronic cholecystitis during ultrasound.

Polyp of the gallbladder

Ultrasound of the gallbladder with polyps

There are adenomatous and cholesterol polyps of the gallbladder. The most common are cholesterol. The most dangerous are adenomatous. Adenomatous polyps arise from the cells of the gallbladder mucosa. For the most part, they do not bother a person in any way and are an accidental finding during ultrasound of the gallbladder. Adenomatous polyps may become malignant. If the polyp is more than 1 cm in diameter, there is a high risk that it will be cancerous. There is also a high risk of malignancy (malignancy) if a series of repeated ultrasounds of the gallbladder shows a rapid growth of the polyp. The tactics for identified polyps is as follows: if the polyp is larger than 1 cm in diameter, it must be removed. With ultrasound of the gallbladder, it is not always possible to reliably distinguish between cholesterol and adenomatous polyps. Therefore, the recommendation for surgical removal is general. If the size of the polyp is less than 1 cm, two studies are performed after 3 and after 6 months. In the absence of growth, surgery is not required.

Ultrasound of the gallbladder in malignant tumors

The most common malignant tumor of the gallbladder is adenocarcinoma. About 70-80% of cases are associated with cholelithiasis. More often women are ill than men. The average age of the patients is 70 years. Ultrasound of the gallbladder usually reveals a subhepatic formation, often replacing the gallbladder, thickening of the walls of the gallbladder, sometimes stones and polyps (more than 2 cm in diameter) in the lumen of the gallbladder, damage to nearby organs and lymph nodes.

Intrahepatic and extrahepatic bile ducts are also examined along with an ultrasound of the gallbladder. E.Yu.

Gallbladder diseases from the point of view of specialists

Our body is full of important structures. Each structure has a specific function, and they all work in harmony. If any disruption occurs, many systems will be affected.

Today we will talk about gallbladder disease. But before we start, let’s learn more about the gallbladder.

The gallbladder is a small sac located under the liver. It stores bile, the digestive juice that is produced by the liver. Before eating, the gallbladder is full of bile and about the size of a small pear. After eating, it becomes empty, like a deflated balloon.

When we eat, signals are sent to the gallbladder. The gallbladder pushes stored bile into the small intestine through the bile ducts. Bile helps digest fatty foods, but removing the gallbladder will cause no noticeable problems in a healthy person other than fat malabsorption or diarrhea.

But what makes someone have their gallbladder removed?

When there is a problem with the gallbladder, it is likely to be removed.

Gallbladder disease is usually the main reason for gallbladder removal. Gallbladder disease includes inflammation, stones, infection, or even blockage of the gallbladder. This is a broad term that includes several types of states.

Any obstruction of the outflow of the gallbladder or any stone formation will cause inflammation of the gallbladder.

Inflammation of the gallbladder is called cholecystitis. If left untreated, this inflammation can lead to serious life-threatening conditions.

Inflammation of the gallbladder can be caused by many reasons:

• Stones in the gallbladder. For unclear reasons, a substance in bile that can crystallize forms gallstones. Too much bile salts, cholesterol, or bilirubin in bile can cause stones to form. These gallstones may be harmless, but they can also cause inflammation, pain, nausea, vomiting, and bile duct blockage. If they block the cystic duct through which bile exits the gallbladder, this leads to a buildup of bile and, as a result, inflammation and infection. If the inflammation is not treated, it can develop into a life-threatening condition. There are different types of gallstones, including cholesterol, pigmented, and mixed.
• Blockage of the bile ducts. This may be associated with bile stones, kinking or scarring of the bile ducts, which also leads to bile accumulation and cholecystitis.
• Tumors of the gallbladder. They can block the flow of bile from the gallbladder.
• Infectious disease. Some infections, such as AIDS, can cause cholecystitis.
• Disease of the blood vessels. Any problem with the blood supply to the gallbladder will lead to functional problems, and inflammation of the gallbladder is one of them.

Inflammation of the gallbladder usually presents with specific symptoms, which depend on whether the inflammation is chronic or acute.

Some of the most common symptoms associated with cholecystitis are:

• Severe pain in the center or right upper abdomen.
• Pain in the right shoulder or back.
• Nausea.
• Vomiting.
• High temperature.
• Soreness in the abdomen.
• Abdominal cramps or bloating.
• Chill.

These symptoms appear suddenly if the disease is acute or develop slowly over the years if the disease is chronic.

In addition to these symptoms, in chronic cases, patients may have light-colored stools, itching, and jaundice.

Jaundice is when the skin, mucous membranes and whites of the eyes have a yellowish tint.

The symptoms are especially pronounced when the patient eats fatty foods. A typical attack lasts from hours to three days. Patients may not experience all symptoms; this will vary from one person to another.

We mentioned earlier that these bouts of inflammation can lead to serious complications, so what are these complications?

Serious complications of cholecystitis include:

• Gallbladder infection . A buildup of bile in the gallbladder can lead to infection and cause further inflammation and pain.
• Gallbladder perforation. Swelling and infection of the gallbladder can cut off the blood supply to the gallbladder wall. And if the wall of the gallbladder is dead, it can be easily torn or punctured.
• Necrosis or gangrene of the gallbladder tissue. This is the most serious complication, especially in the older age group, in untreated patients and in patients with diabetes. This can eventually lead to perforation or rupture of the gallbladder.
• Pancreatitis. Backflow of bile into the pancreas can cause digestion of the pancreatic tissue itself and cause severe inflammation.
• Enlarged gallbladder. Due to swelling and inflammation, the gallbladder may be painful and enlarged, which may be felt on the abdominal wall.
• Gallbladder cancer. This is a rare complication and it takes a long time for gallbladder cancer to develop.

Now let’s move on to another type of gallbladder disease.

Let’s talk more about gallstones , why they form and some of the risk factors that contribute to their formation.

Gallstones tend to form when the gallbladder does not empty completely or often enough. They can be as small as a grain of sand or as big as a golf ball.

The most common risk factors for gallstones are:

• Obesity.
• Diabetes.
• Elderly, over 60 years old.
• Family history of gallstones.
• Female.
• Medicines containing estrogen.
• Cirrhosis of the liver or other diseases of the liver.

There is another disease – choledocholithiasis. This occurs when gallstones block the bile ducts and thus the gallbladder becomes enlarged and inflamed.

Choledocholithiasis blocks the flow of bile from the liver to the intestines and causes:

• Severe pain in the center or right upper abdomen.
• High temperature.
• Chill.
• Nausea.
• Vomiting.
• Jaundice.
• Clay colored chair.

Another strange disease of the gallbladder – acalculous cholecystitis . This is an inflammation of the gallbladder without gallstones. It is associated with serious illnesses or chronic diseases. Some of them:

• Severe injury.
• Severe burns.
• Heart surgery.
• Abdominal surgery.
• Autoimmune diseases such as lupus.
• Severe bacterial or viral disease.
• Long-term intravenous nutrition.

The symptoms of acalculous cholecystitis are similar to acute cholecystitis with stones.

Have you heard of biliary dyskinesia?

This is one of the diseases of the gallbladder that occurs when the gallbladder functions less than normal. This may be due to inflammation of the gallbladder.

There are no gallstones in biliary dyskinesia, it is usually provoked by fatty foods. Symptoms include bloating, indigestion, nausea, and abdominal pain after eating.

This condition requires a special gallbladder function test called a HIDA scan. If the gallbladder can only secrete 30–45% or less of bile, then the disease is confirmed.

Now let’s talk about another autoimmune disease that affects the urinary system and can lead to scarring of the bile duct. It’s sclerosing cholangitis, ongoing inflammation of the bile duct system, which can lead to damage to it. Approximately 60 to 80% of people with sclerosing cholangitis also have ulcerative colitis. The only known treatment for this condition is a liver transplant. Medicines that suppress the immune system can only manage the symptoms.

Gallbladder polyps . They are abnormal growths that occur inside the gallbladder. They do not cause symptoms and are most often benign. However, if the polyp is larger than 1 cm, it is better to remove the entire gallbladder for fear of malignancy.

When the gallbladder fills with pus, it is called gallbladder abscess . Patients with a gallbladder abscess complain of pain in the upper right corner of the abdomen, fever, and severe chills. This condition can occur in acute cholecystitis, when a stone blocks the gallbladder and it fills with white blood cells, bacteria, and dead tissue.

Another disease – gangrene of the gallbladder , and this is one of the most serious complications of acute cholecystitis, which develops with insufficient blood supply to the gallbladder. Patients usually present with a clinical presentation of gallbladder dull pain, fever, nausea, vomiting, low blood pressure, and confusion. Men over 45 and diabetics are at greater risk of developing gallbladder gangrene.

Gallbladder cancer . This is a rare disease in which malignant cells are found in the tissue of the gallbladder. Gallbladder stones are a very common risk factor for cancer in the long term. Female gender increases the risk of gallbladder cancer. The evil fact associated with this disease is that it is not detected and diagnosed until late in the progression of the disease. Symptoms and signs of gallbladder cancer may be similar to acute cholecystitis. Besides, there were no symptoms. It can quietly spread from the inner layer to the outer, and then to the lymph nodes, liver and other organs. Ironically, gallbladder cancer can be detected when the gallbladder is removed for other reasons.

So far we have covered the most common gallbladder diseases. But we have not yet explained how they are diagnosed or treated.

Our task today is to answer most of your questions regarding gallbladder disease. Our guest today is Dr. Choi, a renowned physician at Hanyang University Hospital in Seoul, Korea. He’s going to discuss gallbladder disease with us from an expert point of view.

Interviews:

What can you say about the gallbladder? Could you elaborate more on the gallbladder and its symptoms?

Gallbladder, in Korean called Damnang or Ssulgae . .. the most important role of this organ is the production of bile. Bile is produced in the liver and then sent to the gallbladder for temporary storage. The most common problem is the development of stones. Gallstones prevent the accumulation and outflow of bile, so the gallbladder becomes inflamed and pain occurs, this is called gallstone disease. Sometimes a polyp forms in the gallbladder. If left alone, a polyp can turn into cancer, which is why we believe it is a condition that needs to be treated. In particular, adenomatous polyps and gallstones must be removed by laparoscopic surgery. There is no other way to remedy the situation other than a removal operation.

Did we just talk about gallstones? How to treat gallstone disease?

As I mentioned, a long time ago drugs were prescribed or injected topically into the affected area, but this did not make sense, as gallstones would form again. Thus, laparoscopic cholecystectomy, which is a relatively simple operation, is currently used to treat this condition. Of course, there are doubts, since this is the removal of an organ, but if stones have formed in the gallbladder, then this means that it is not doing its job, so the best solution is to remove the gallbladder.

Are there any better ways to prevent this from the start than treatment?

The most important thing is eating habits. The main reasons for the development of gallstones is the consumption of fatty foods, another reason is in Korea for a long time, seafood such as crustaceans and fish were consumed raw, which sometimes led to parasites that cause infections that cause gallstones, which are now largely gone. Recently, the more common cause is the consumption of fatty foods, which causes many gallstones, and obesity also increases the likelihood of gallstones. Women are often more likely to form gallstones during pregnancy. In general, there are many reasons why gallstones occur. You can leave this condition as it is, but if it causes pain or other symptoms, you need to remove the gallbladder. So, the most important way to reduce the likelihood of gallstones is to control your eating habits.

What about gallbladder cancer?

Gallbladder stones are a condition that we often see, and if left untreated for a long period, many of them turn into cancer. Because if there are stones in the gallbladder, inflammation occurs, and if it is not treated for a long time, cancer develops. Not everything leads to cancer, but if the stones are large or the gallbladder is thickened, then even if there are no symptoms, we are advised to remove the gallbladder because it can turn into cancer. Thus, cancer tends to develop if gallstones are left untreated for a long period. Even here, I would say that 10% to 20% probably have gallstones but show no symptoms. In such cases, so far, everything is fine, but as they age and they are 60 or 70 years old, cancer can develop because the inflammation has been prolonged. So, if there are gallstones or if the bladder is thickened, prompt removal is the solution to prevent cancer.

Are there any symptoms in case of gallbladder cancer?

In most cases, there are no symptoms. When symptoms occur, it is usually jaundice or pain, in which case it is already too late. Even today I have operated on a patient who had no symptoms but had cancer with spread. Thus, periodic checkups are key to preventing gallbladder cancer, especially if there are problems. Even if there is a small problem, it is best to remove it before it becomes cancerous.

Is surgery the only way to cure this?

Yes. Chemotherapy is ineffective, especially for gallbladder cancer. So in the early stages quickly… there are two ways to get to cancer… due to polyps or gallstones, in both cases, if the gallbladder is removed quickly, there is no chance of developing cancer. Otherwise, a person grows a disease for himself. If symptoms show up later, it’s already too late. Then a simple operation may not work, and instead of simply removing the gallbladder, parts of the liver, gallbladder, and other organs such as the duodenum may need to be removed. .. This becomes a huge surgical procedure, so it’s best done early.

My last question, professor… I would suggest that the way to prevent gallbladder disease is the same as the way to prevent gallbladder cancer, right?

Preventing gallbladder cancer is like preventing gallstones. Preventing the formation of gallstones is the control of eating habits. But that doesn’t always mean that cancer is preventable. For example, in Korea, 20% to 30% have gallstones in one form or another – these people need to have a monthly examination to detect an enlarged gallbladder, or if the stones increase in number, or if the gallbladder thickens, then if it is not removed beforehand, it can become malignant. Thus, frequent check-ups are necessary to prevent cancer if gallstones or polyps are present, and removal of the gallbladder must be done at an early stage to prevent cancer. If left alone, it can suddenly and asymptomatically turn into cancer. Early detection and rapid removal is the best method of cancer prevention.

Conclusion

The most important role of the gallbladder is the production of bile. Bile is produced in the liver and then sent to the gallbladder for temporary storage. The most common problem is the development of stones. So, gallstones prevent the accumulation and outflow of bile, so the gallbladder becomes inflamed and pain occurs, which is called gallstone disease. Another disease is the development of polyps. If polyps are left alone, cancer can develop, which is why we believe this is a condition that needs to be treated. First of all, these are adenomatous polyps and gallstones, which must be removed using laparoscopic surgery. There is no other way to remedy the situation other than a removal operation.

The most important prevention is eating habits. The main reasons for the development of gallstones is the consumption of fatty foods, another reason is in Korea for a long time, seafood such as crustaceans and fish were consumed raw, which sometimes led to parasites that cause infections that cause gallstones, which are now largely gone.