What are the main types of gallbladder disease. How does cholecystitis affect the gallbladder. What causes gallstones to form. Can gallbladder disease occur without gallstones. How is biliary dyskinesia diagnosed. What are the risk factors for acalculous gallbladder disease.

Understanding Gallbladder Disease: An In-Depth Look

Gallbladder disease encompasses a range of conditions that affect the small, pear-shaped organ located beneath the liver. This vital component of the digestive system is responsible for storing bile produced by the liver and releasing it into the small intestine to aid in fat digestion. When the gallbladder malfunctions, it can lead to various health issues, some of which can be severe if left untreated.

The majority of gallbladder diseases stem from inflammation of the gallbladder walls, a condition known as cholecystitis. This inflammation often results from gallstones blocking the ducts that lead to the small intestine, causing bile to accumulate. In severe cases, this can progress to tissue destruction (necrosis) or gangrene.

Gallstones: The Primary Culprit in Gallbladder Disease

Gallstones are perhaps the most well-known gallbladder issue. These hard particles form when substances in the bile, such as cholesterol, bile salts, and calcium, or blood components like bilirubin, crystallize. Gallstones can vary dramatically in size, ranging from tiny grains of sand to golf ball-sized masses.

Several factors increase the risk of developing gallstones:

• Obesity or being overweight
• Diabetes
• Age (60 years or older)
• Use of estrogen-containing medications
• Family history of gallstones
• Female gender
• Crohn’s disease and other conditions affecting nutrient absorption
• Cirrhosis or other liver diseases

Is gallstone formation preventable? While some risk factors are beyond our control, maintaining a healthy weight, exercising regularly, and following a balanced diet can significantly reduce the likelihood of developing gallstones.

Cholecystitis: Acute and Chronic Inflammation of the Gallbladder

Cholecystitis, the most common type of gallbladder disease, can manifest as either acute or chronic inflammation. Acute cholecystitis typically results from gallstones obstructing the gallbladder, although tumors or other illnesses can also cause it. Symptoms often include sharp pain in the upper right or upper middle abdomen, particularly after meals, which may radiate to the right shoulder.

Other symptoms of acute cholecystitis include:

• Fever
• Nausea
• Vomiting
• Jaundice

Chronic cholecystitis develops after multiple episodes of acute cholecystitis. Over time, the gallbladder may shrink and lose its ability to store and release bile effectively. This condition can cause persistent abdominal pain, nausea, and vomiting, often requiring surgical intervention.

Choledocholithiasis: When Gallstones Obstruct Bile Ducts

Choledocholithiasis occurs when gallstones become lodged in the neck of the gallbladder or in the bile ducts. This obstruction prevents bile from exiting the gallbladder, potentially leading to inflammation or distention. Moreover, the blockage can impede bile flow from the liver to the intestines, resulting in a range of symptoms:

• Intense pain in the upper middle abdomen
• Fever and chills
• Nausea and vomiting
• Jaundice
• Pale- or clay-colored stools

How is choledocholithiasis diagnosed? Doctors typically use a combination of imaging techniques, such as ultrasound, CT scans, or MRCP (magnetic resonance cholangiopancreatography), along with blood tests to detect elevated liver enzymes and bilirubin levels.

Acalculous Gallbladder Disease: Inflammation Without Stones

Acalculous gallbladder disease is a unique condition characterized by gallbladder inflammation in the absence of gallstones. This condition is often associated with severe chronic illnesses or serious medical conditions. The symptoms closely resemble those of acute cholecystitis with gallstones.

Risk factors for acalculous gallbladder disease include:

• Severe physical trauma
• Heart or abdominal surgery
• Severe burns
• Autoimmune conditions like lupus
• Blood stream infections
• Receiving nutrition intravenously (IV)
• Significant bacterial or viral illnesses

Why does acalculous gallbladder disease occur in critically ill patients? The exact mechanism is not fully understood, but it’s believed that factors such as decreased gallbladder motility, altered bile composition, and systemic inflammation contribute to its development in these vulnerable populations.

Biliary Dyskinesia: When the Gallbladder Underperforms

Biliary dyskinesia is a functional disorder characterized by a lower-than-normal gallbladder function. This condition may be related to chronic gallbladder inflammation and can cause symptoms such as upper abdominal pain after eating, nausea, bloating, and indigestion. Notably, fatty meals often trigger these symptoms.

Unlike other gallbladder diseases, biliary dyskinesia typically occurs without the presence of gallstones. Diagnosis often requires a specialized test called a HIDA scan, which measures gallbladder function. If the gallbladder can only release 35 to 40 percent of its contents or less, biliary dyskinesia is usually diagnosed.

The HIDA Scan: A Closer Look

The HIDA (hepatobiliary iminodiacetic acid) scan is a nuclear medicine procedure that evaluates the function of the gallbladder and bile ducts. During this test, a radioactive tracer is injected into the bloodstream, which is then taken up by liver cells and excreted into the bile. The movement of this tracer is tracked using a special camera, allowing doctors to assess how well the gallbladder is functioning.

Sclerosing Cholangitis: A Progressive Bile Duct Disease

Sclerosing cholangitis is a chronic, progressive condition characterized by inflammation and scarring of the bile ducts. While the exact cause remains unknown, this disease can lead to serious complications if left untreated.

Interestingly, nearly half of the people with sclerosing cholangitis don’t experience symptoms initially. When symptoms do manifest, they may include:

• Fever
• Jaundice
• Itching
• Upper abdominal discomfort

A striking association exists between sclerosing cholangitis and ulcerative colitis, with approximately 60 to 80 percent of patients with sclerosing cholangitis also having ulcerative colitis. Moreover, this condition increases the risk of liver cancer.

Is there a cure for sclerosing cholangitis? Currently, the only known cure is a liver transplant. However, various treatments can help manage symptoms and slow the progression of the disease.

Diagnosing Gallbladder Disease: A Multifaceted Approach

Accurate diagnosis of gallbladder disease is crucial for effective treatment. Doctors employ a variety of diagnostic tools and techniques to identify the specific condition affecting a patient’s gallbladder.

Imaging Techniques

Several imaging methods can help visualize the gallbladder and surrounding structures:

• Ultrasound: Often the first-line imaging test, ultrasound can detect gallstones and gallbladder inflammation.
• CT scan: Provides detailed images of the gallbladder and can identify complications such as perforation or abscess formation.
• MRCP: A specialized MRI technique that produces detailed images of the biliary and pancreatic ducts.
• ERCP: Combines endoscopy and X-rays to diagnose and treat problems in the bile ducts and pancreatic duct.

Blood Tests

Blood tests can reveal important information about liver function and the presence of infection:

• Liver function tests: Elevated levels of certain enzymes may indicate gallbladder or liver problems.
• Complete blood count: Can detect signs of infection or inflammation.
• Bilirubin levels: Elevated bilirubin can indicate a bile duct obstruction.

Other Diagnostic Procedures

In some cases, additional tests may be necessary:

• HIDA scan: As mentioned earlier, this test assesses gallbladder function.
• Endoscopic ultrasound: Combines endoscopy with ultrasound to provide detailed images of the biliary system.
• Cholangiography: Involves injecting a contrast dye to visualize the bile ducts on X-rays.

How do doctors determine which diagnostic tests to use? The choice of diagnostic tools depends on the patient’s symptoms, medical history, and initial examination findings. Often, a combination of tests is necessary to arrive at an accurate diagnosis.

Treatment Options for Gallbladder Disease

The treatment of gallbladder disease varies depending on the specific condition and its severity. Options range from conservative management to surgical intervention.

Conservative Management

For mild cases or when surgery is not immediately necessary, conservative treatments may include:

• Dietary modifications: Reducing fat intake and avoiding trigger foods.
• Pain management: Over-the-counter or prescription pain relievers.
• Antibiotics: In cases of infection.
• Ursodeoxycholic acid: A medication that can help dissolve small gallstones over time.

Surgical Interventions

Surgery is often the definitive treatment for many gallbladder conditions:

• Cholecystectomy: Surgical removal of the gallbladder, usually performed laparoscopically.
• ERCP with stone extraction: For removing gallstones lodged in the bile ducts.
• Percutaneous cholecystostomy: A temporary drainage procedure for critically ill patients who cannot undergo immediate surgery.

When is surgery necessary for gallbladder disease? Surgery is typically recommended for recurrent gallstone attacks, complications such as cholecystitis or choledocholithiasis, or when conservative measures fail to provide relief.

Living Without a Gallbladder: What to Expect

Many people worry about the consequences of living without a gallbladder. However, the body can adapt to its absence relatively well. After gallbladder removal:

• Bile flows directly from the liver to the small intestine instead of being stored and concentrated in the gallbladder.
• Some patients may experience temporary digestive changes, such as diarrhea or fatty food intolerance.
• Most individuals can return to a normal diet and lifestyle after a recovery period.

Are there long-term consequences of gallbladder removal? While most people adapt well, a small percentage may experience ongoing digestive issues. These can often be managed with dietary adjustments and, in some cases, medication.

Preventing Gallbladder Disease: Lifestyle Factors

While some risk factors for gallbladder disease are beyond our control, several lifestyle modifications can help reduce the risk:

• Maintaining a healthy weight: Obesity is a significant risk factor for gallstones.
• Regular exercise: Physical activity can help prevent gallstone formation.
• Balanced diet: Eating a diet rich in fiber and low in saturated fats may reduce risk.
• Staying hydrated: Adequate fluid intake helps maintain proper bile flow.
• Avoiding rapid weight loss: Crash diets can increase the risk of gallstone formation.

Can dietary supplements prevent gallbladder disease? While some studies suggest that certain supplements, such as vitamin C, may reduce the risk of gallstones, more research is needed. It’s always best to consult with a healthcare provider before starting any supplement regimen.

The Future of Gallbladder Disease Management

Research in the field of gallbladder disease continues to advance, promising improved diagnostic and treatment options in the future:

• Genetic studies: Identifying genetic factors that increase susceptibility to gallbladder disease.
• Advanced imaging techniques: Developing more precise and less invasive diagnostic tools.
• Novel treatments: Exploring new medications and minimally invasive procedures for managing gallbladder conditions.
• Personalized medicine: Tailoring treatments based on individual patient characteristics and disease profiles.

What breakthroughs can we expect in gallbladder disease treatment? While it’s difficult to predict specific advancements, ongoing research aims to develop more effective, less invasive treatments and improved preventive strategies.

Understanding gallbladder disease is crucial for early detection and effective management. By recognizing the symptoms, risk factors, and available treatment options, individuals can take proactive steps to maintain their gallbladder health and overall well-being. As medical science continues to evolve, we can look forward to even better ways of diagnosing, treating, and preventing these common yet potentially serious conditions.

Gallbladder Disease: Overview, Types, and Diagnosis

Gallbladder disease can include gallstones, cholecystitis, cancer, and other diseases that affect gallbladder function. A buildup of bile can prevent the gallbladder from emptying and cause inflammation in the gallbladder walls.

Overview of gallbladder disease

The term gallbladder disease is used for several types of conditions that can affect your gallbladder.

The gallbladder is a small pear-shaped sac located underneath your liver. Your gallbladder’s main function is to store the bile produced by your liver and pass it along through a duct that empties into the small intestine. Bile helps you digest fats in your small intestine.

Inflammation causes the majority of gallbladder diseases due to irritation of the gallbladder walls, which is known as cholecystitis. This inflammation is often due to gallstones blocking the ducts leading to the small intestine and causing bile to build up. It may eventually lead to necrosis (tissue destruction) or gangrene.

There are many different types of gallbladder disease.

Gallstones

Gallstones develop when substances in the bile (such as cholesterol, bile salts, and calcium) or substances from the blood (like bilirubin) form hard particles that block the passageways to the gallbladder and bile ducts.

Gallstones also tend to form when the gallbladder doesn’t empty completely or often enough. They can be as small as a grain of sand or as large as a golf ball.

Numerous factors contribute to your risk of gallstones. These include:

• being overweight or obese
• having diabetes
• being age 60 or older
• taking medications that contain estrogen
• having a family history of gallstones
• being female
• having Crohn’s disease and other conditions that affect how nutrients are absorbed
• having cirrhosis or other liver diseases

Cholecystitis

Cholecystitis is the most common type of gallbladder disease. It presents itself as either an acute or chronic inflammation of the gallbladder.

Acute cholecystitis

Acute cholecystitis is generally caused by gallstones. But it may also be the result of tumors or various other illnesses.

It may present with pain in the upper right side or upper middle part of the abdomen. The pain tends to occur right after a meal and ranges from sharp pangs to dull aches that can radiate to your right shoulder. Acute cholecystitis can also cause:

• fever
• nausea
• vomiting
• jaundice

Chronic cholecystitis

After several attacks of acute cholecystitis, the gallbladder can shrink and lose its ability to store and release bile. Abdominal pain, nausea, and vomiting may occur. Surgery is often the needed treatment for chronic cholecystitis.

Choledocholithiasis

Gallstones may become lodged in the neck of the gallbladder or in the bile ducts. When the gallbladder is plugged in this way, bile can’t exit. This may lead to the gallbladder becoming inflamed or distended.

The plugged bile ducts will further prevent bile from traveling from the liver to the intestines. Choledocholithiasis can cause:

• extreme pain in the middle of your upper abdomen
• fever
• chills
• nausea
• vomiting
• jaundice
• pale- or clay-colored stools

Acalculous gallbladder disease

Acalculous gallbladder disease is inflammation of the gallbladder that occurs without the presence of gallstones. Having a significant chronic illness or serious medical condition has been shown to trigger an episode.

Symptoms are similar to acute cholecystitis with gallstones. Some risk factors for the condition include:

• severe physical trauma
• heart surgery
• abdominal surgery
• severe burns
• autoimmune conditions like lupus
• blood stream infections
• receiving nutrition intravenously (IV)
• significant bacterial or viral illnesses

Biliary dyskinesia

Biliary dyskinesia occurs when the gallbladder has a lower-than-normal function. This condition may be related to ongoing gallbladder inflammation.

Symptoms can include upper abdominal pain after eating, nausea, bloating, and indigestion. Eating a fatty meal may trigger symptoms. There are usually no gallstones in the gallbladder with biliary dyskinesia.

Your doctor may need to use a test called a HIDA scan to help diagnosis this condition. This test measures gallbladder function. If the gallbladder can only release 35 to 40 percent of its contents or less, then biliary dyskinesia is usually diagnosed.

Sclerosing cholangitis

Ongoing inflammation and damage to the bile duct system can lead to scarring. This condition is referred to as sclerosing cholangitis. However, it’s unknown what exactly causes this disease.

Nearly half the people with this condition don’t have symptoms. If symptoms do occur, they can include:

• fever
• jaundice
• itching
• upper abdominal discomfort.

Approximately 60 to 80 percent of people with this condition also have ulcerative colitis. Having this condition does increase the risk of liver cancer as well. Currently, the only known cure is a liver transplant.

Medications that suppress the immune system and those that help break down thickened bile can help manage symptoms.

Gallbladder cancer

Cancer of the gallbladder is a relatively rare disease. There are different types of gallbladder cancers. They can be difficult to treat because they’re not often diagnosed until late in the disease’s progression. Gallstones are a common risk factor for gallbladder cancer.

Gallbladder cancer can spread from the inner walls of the gallbladder to the outer layers and then on to the liver, lymph nodes, and other organs. The symptoms of gallbladder cancer may be similar to those of acute cholecystitis, but there may also be no symptoms at all.

Gallbladder polyps

Gallbladder polyps are lesions or growths that occur within the gallbladder. They’re usually benign and have no symptoms. However, it’s often recommended to have the gallbladder removed for polyps larger than 1 centimeter. They have a greater chance of being cancerous.

Gangrene of the gallbladder

Gangrene can occur when the gallbladder develops inadequate blood flow. This is one of the most serious complications of acute cholecystitis. Factors that increase the risk of this complication include:

• being male and over 45 years old
• having diabetes

The symptoms of gallbladder gangrene can include:

• dull pain in the gallbladder region
• fever
• nausea or vomiting
• disorientation
• low blood pressure

Abscess of the gallbladder

Abscess of the gallbladder results when the gallbladder becomes inflamed with pus. Pus is the accumulation of white blood cells, dead tissue, and bacteria. Symptoms may include upper right-sided pain in the abdomen along with fever and shaking chills.

This condition can occur during acute cholecystitis when a gallstone blocks the gallbladder completely, allowing the gallbladder to fill with pus. It’s more common in people with diabetes and heart disease.

To diagnose gallbladder disease, your doctor will ask you about your medical history and perform an abdominal exam. This will include checking for pain in the abdomen. One or more of the following tests and procedures may be used:

Detailed medical history

A list of symptoms you’re experiencing and any personal or family history of gallbladder disease are important. A general health assessment may also be performed to determine if there are any signs of a long-term gallbladder disease.

Physical exam

Your doctor may perform a special maneuver during the abdominal exam to look for what’s referred to as “Murphy’s sign.”

During this maneuver, your doctor will put their hand on your abdomen over the area of the gallbladder. They’ll then ask you to take a breath while examining and feeling the area. If you feel significant pain, it suggests you may have gallbladder disease.

Chest and abdominal X-ray

Symptomatic cholecystitis will sometimes show stones on abdominal X-rays if the stones contain calcium. An X-ray of the chest may show pleurisy or pneumonia.

However, X-rays aren’t the best test for identifying gallbladder disease. They’re often used to rule out other potential causes of pain that’s not related to gallstones, the gallbladder, or the liver.

Ultrasound

An ultrasound uses sound waves to produce images inside your body. This test is one of the main methods your doctor uses to make a diagnosis of gallbladder disease. An ultrasound can evaluate the gallbladder for the presence of gallstones, thickened walls, polyps, or masses. It can also identify any issues within your liver.

HIDA scan

A HIDA scan looks at the duct system within the gallbladder and liver. It’s often used when a person has gallbladder symptoms but the ultrasound didn’t show a reason for the symptoms. A HIDA scan can also be used for a more thorough evaluation of the bile duct system.

This test can evaluate the function of the gallbladder using a harmless radioactive substance. The substance is injected into a vein and then watched as it moves through the gallbladder. Another chemical may also be injected that causes the gallbladder to release bile.

A HIDA scan shows how the gallbladder moves bile through the bile duct system. It can also measure the rate of bile moving out of the gallbladder. This is known as the ejection fraction. A normal ejection fraction for the gallbladder is considered between 35 to 65 percent.

Other tests

Other imaging tests, such as a CT and MRI scan, can also be used. Blood tests are also done to check for increased white blood cell counts and abnormal liver function.

Endoscopic retrograde cholangiopancreatography (ERCP) is a more invasive but useful test. A flexible camera is inserted into the mouth and down past the stomach into the small intestine. Contrast dye is injected to show the bile duct system with a specialized X-ray.

ERCP is an especially useful test if a blockage due to gallstones is suspected. Any gallstone that is causing blockage can often be removed during this procedure.

Lifestyle changes

Since certain health conditions increase the risk of gallstone formation, changes in lifestyle may help manage gallbladder disease in people without symptoms. Being overweight and having diabetes increases the likelihood of gallstones. Losing weight and getting good control over diabetes may help lower your risk.

However, rapid weight loss can also trigger gallstone formation. Talk to your doctor about safe ways to lose weight.

Increasing physical activity also appears to decrease gallstone formation along with lowering high triglycerides, a type of fat in the blood. It’s often recommended to quit smoking and limit alcohol intake as well.

Medical treatment

The first episode of gallbladder inflammation is often treated with pain medications. Because the pain is often severe, prescription medications are needed. Your doctor may prescribe medications with codeine or hydrocodone. IV prescription anti-inflammatories may be prescribed, or stronger pain medications like morphine.

Over-the-counter medications like ibuprofen (Advil) and naproxen (Aleve) may not be used as often due to the increased risk of nausea and vomiting. If you’re dehydrated, anti-inflammatory drugs may also cause severe kidney issues.

Most people have difficulty managing the pain and its accompanying symptoms at home. Talk with your doctor to discuss the best treatment for you.

Ongoing research is looking into the use of the medication ezetimibe and its role in decreasing the formation of cholesterol gallstones. This medication changes how the body absorbs cholesterol from the intestinal tract.

Surgery

Surgery will be recommended to remove your gallbladder if you’ve experienced multiple episodes of inflammation. Gallbladder surgery continues to be the most effective method for treating active gallbladder disease.

The surgery can be done either by opening your abdomen with an incision, or laparoscopically. This involves making several poke holes through the abdominal wall and inserting a camera. Laparoscopic surgery allows for faster recovery. This method is preferred for people who don’t have complications of significant gallbladder disease.

After gallbladder surgery by either method, it’s not uncommon for people to experience some diarrhea. According to the Mayo Clinic, up to 3 out of 10 people can have diarrhea after gallbladder surgery.

For most people, diarrhea will only last a few weeks. But in a few cases, it can last for years. If diarrhea is continuing after surgery for more than two weeks, talk to your doctor. Depending on other symptoms, you may require follow-up testing.

The gallbladder may form an abnormal passageway, or fistula, between the gallbladder and the intestine to help process the liver’s bile. This is most often a complication of chronic inflammation related to gallstones.

Other complications can include:

• obstruction of the intestine
• inflammation and scarring
• perforation (a hole in the gallbladder)
• bacterial contamination of the abdomen, known as peritonitis
• malignant transformation (the change cells undergo to become a cancerous tumor)

Certain risk factors for gallbladder disease, such as sex and age, can’t be changed. However, your diet may play a role in developing gallstones. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), foods high in fiber and healthy fats may help prevent gallstones.

Refined grains (found in sugary cereals and white rice, bread, and pasta) and sugary sweets are associated with a higher risk of gallbladder disease. Whole grains like brown rice and whole wheat bread and fats from fish and olive oil are all recommended.

The earlier gallbladder problems are recognized and treated, the less likely significant complications will occur. It’s important to talk to your doctor if you’re experiencing any signs or symptoms of gallbladder disease.

Pediatric Gallbladder Disease | Conditions

Blocked Bile Ducts

The gallbladder is a small pouch located under the liver. It stores the fluid, called bile, the liver creates to help process everything your child eats or drinks. As your body digests food, bile is released through a tube that connects the liver to the small intestines. Gallbladder disease occurs when bile builds up in your child’s gallbladder because of gallstones or other issues.

There are two main causes of pediatric gallbladder disease:

• Gallstones form in the gallbladder when substances in your bile form hard particles that block your bile ducts, causing pain and inflammation. Gallstones can be small as a grain of sand or the size of a golf ball.
• Poor gallbladder function stems from a mechanical or functional problem that limits the gallbladder’s ability to contract and expel bile, causing a blockage.

Symptoms, Diagnosis and Outlook

Symptoms of pediatric gallbladder disease vary according to the individual child and the severity of the disease. Common signs include:

• Pain, mostly on the upper right side of the abdomen
• Pain following meals
• Intolerance of any fatty foods
• Nausea and vomiting
• Loss of appetite
• Jaundice, or yellow tinge in the whites of your eyes and skin
• Weight loss

Diagnosis of pediatric gallbladder disease includes:

• Physical examination and review of your family’s health history
• Blood tests to measure the amount of bilirubin in your blood
• Ultrasound to detect whether gallstones or infection are present
• HIDA scan that outlines the path your bile follows and helps detects blockages

Most gallbladder disease can be effectively treated with surgical removal of the gallbladder. Long-term results following surgery are typically positive.

Our Experts in Care

The pediatric surgeons at Penn State Health Children’s Hospital pair advanced expertise with leading-edge technology to diagnose and treat gallbladder disease in children and adolescents of all ages.

Find a Doctor Near You

Why Choose Penn State Health Children’s Hospital for Care

Minimally Invasive Surgery

If there is a clear indication of gallstone disease or function problems, your child may need surgery. The pediatric surgeons at Penn State Health Children’s Hospital use minimally invasive surgical techniques whenever possible to minimize the procedure’s impact on your child’s body, reduce pain and shorten recovery time.

Surgery is usually performed on an outpatient basis, often with an overnight stay. The operation is performed laparoscopically, using small “poke holes” in the abdomen in place of a traditional large incision. Your pediatric surgeon will discuss the pros and cons of gallbladder surgery to help you make an informed decision about your child’s care.

Ranked Among the Nation’s Best

Penn State Health Children’s Hospital is proud to be one of the nation’s top children’s hospitals.

• U.S. News and World Report has ranked us as one of the best children’s hospitals every year. Learn more about our rankings. We are one of only 84 children’s hospitals recognized in any specialty.
• We are one of eight hospitals in the country, and the only one in Pennsylvania, to be named as a Level 1 Children’s Surgery Center by The American College of Surgeons (ACS) for excellence in pediatric surgical care.

Support Groups

Support groups provide children and their families an opportunity to connect with others in similar situations. Learn more about the support groups offered at Penn State Health Children’s Hospital.

View All Support Groups

Our Convenient Locations

Find the care your family needs, close to home, at one of our many locations throughout central Pennsylvania.

Find a Location Near You

5 misconceptions about the liver that make a hepatologist spoil his mood

Many people have rather vague ideas about the liver. Not everyone knows where this organ is located, but at the same time they believe in the need to clean, protect and heal it. These and other false beliefs lead to serious problems – we will consider them with a hepatologist, gastroenterologist Fedel Sadek.

“From time to time I feel pain and heaviness in the liver”

Let’s start with the fact that even a diseased liver does not hurt, it has no nerve endings. A person begins to feel discomfort in the right hypochondrium already in severe stages of cirrhosis, when the organ is greatly enlarged in size and approximately 15% of the cells remain in working condition.

Hepatologist Fedel Sadek: “Outwardly and clinically, liver diseases do not manifest themselves in any way – this is their cunning. Sometimes even stage 2 fibrosis is asymptomatic. People get hepatitis B or C for 15-20 years, but they learn about it when the disease has already passed into the irreversible stage of cirrhosis. So when patients complain about “pain” in the liver, I understand that there may be problems with the stomach, pancreas or gallbladder. We are starting to diagnose these organs.”

To monitor the condition of the liver, take a biochemical blood test with liver markers once a year:
AST and ALT – enzymes inside the liver cells.
Gamma-GTP and ALP (alkaline phosphatase ) – increase in toxic and alcoholic hepatitis.
Bilirubin, total, direct indicates acute hepatitis or damage to liver cells.
HBsAg, Anti HBcorlgM and HCV PCR — Hepatitis B and C markers.

“The liver needs to be cleansed, especially after parties”

This is the most common misconception and is actively supported by the rapidly growing detox industry. Fans of liver cleansing use both folk methods like a spoonful of oil on an empty stomach and herbal infusions, as well as trendy dietary supplements, juices, extracts, as well as ozone therapy and therapeutic fasting.

The idea that the liver is constantly polluted did not arise by chance. This organ is the main filter in our body. After the intestines have digested everything we have eaten and drunk, the blood carries it to the liver. It filters everything, neutralizes toxins, breaks down alcohol, produces bile and is involved in many other important processes. But the liver itself is not polluted, it is self-sufficient and able to cope with detoxification without our help.

Hepatologist Fedel Sadek: “I see a craze for fasting, which often leads to a violation of the contractile function of the gallbladder, a lot of bile accumulates in it, and then gradually leads to the formation of stones. “Cleansing” with a shock dose of choleretic agents causes the liver to produce an inadequate amount of bile, which is hardly processed in the intestines. And if there were stones in the hepatic ducts (which a person may not know about), then there is a risk of blockage of the ducts and the development of acute cholecystitis.

Instead of dubious and dangerous cleansing, you can take care of the liver in adequate ways:
– if you drink alcohol, then in moderate doses: for men – 350 ml of beer, 150 ml of wine or 45 ml of vodka, for women – half as much;
– maintain normal body weight (BMI – 18-25 units) through a healthy diet and physical activity;
– do not overdo it with medication, observe the rules of hygiene in public places, choose protected sex.

“Hepatoprotectors protect my liver cells and improve its functioning”

There is an opinion that you can drink every day and eat mayonnaise with spoons, and hepatoprotectors will fix everything: “improve liver function”, “protect cells from damage”, “cleanse toxins”. Among hepatoprotectors there are preparations of animal and vegetable origin, essential phospholipids (EPL), as well as amino acids and antioxidants. The most popular are herbal products, such as milk thistle extract, artichoke leaves, pumpkin seeds, dandelion root, licorice, Indian herbs.

Hepatologist Fedel Sadek: “There is no reliable scientific data confirming the positive effect of hepatoprotectors on the liver. However, there are clinical studies that have shown that essential phospholipids used only intravenously can have a positive effect in cirrhosis of the liver.

In the US, hepatoprotectors are considered dietary supplements and are not regulated by the Food and Drug Administration (FDA). Moreover, they can be toxic to the liver. Many people think that all natural is healthy and safe, but studies confirm that herbal dietary supplements are not only ineffective in liver diseases, but, according to studies, in 20% of cases they cause liver diseases.

“I can’t have fatty liver, because I’m not fat”

Doctors advise against relaxing, because fatty liver is a common diagnosis that occurs at any age, both among obese and quite slender people. Fatty liver disease, or non-alcoholic fatty liver disease (NAFLD), is a disease in which fat accumulates in the liver cells, and its mass is more than 5-10% of the mass of the liver itself. So that fatty liver does not come as a surprise to you, after the age of 40, it is necessary to do an abdominal ultrasound every year, check blood pressure and blood sugar levels.

Hepatologist Fedel Sadek: “A person may not be overweight, the cause of hepatosis lies elsewhere, for example, lipid metabolism disorders, hormonal changes, hereditary hypercholesterolemia, metabolic syndrome, type 2 diabetes, kidney disease . All this can lead to the deposition of fat cells inside hepatocytes and the development of non-alcoholic fatty liver disease, so we always look for the cause and treat it.”

“If you take statins all your life, you can “kill” the liver”

On the one hand, about a thousand drugs and drug combinations can lead to drug-induced hepatitis. Complications develop with long-term use of drugs, high dosages and with individual intolerance. The first place in hepatotoxicity is occupied by painkillers and anti-inflammatory drugs, antibiotics are in second place, antitumor drugs are in third place, and phytopreparations are in fourth place.

But statins do not provoke a hepatotoxic effect. They are vital to reduce the level of “bad” cholesterol in the blood at a high risk of thrombosis. Once you start taking statins, you will have to take them for the rest of your life. Therefore, patients are afraid for the liver.

Hepatologist Fedel Sadek: “Sometimes statin use causes a slight increase in the level of enzymes (transaminases) that indicate inflammation or damage to liver cells. But most often this does not lead to liver problems. You can continue taking statins by regularly monitoring liver markers. Either way, the benefits of statins outweigh the other risks.”

Our liver has a unique ability to repair damaged cells. If there is no cirrhosis, then all other conditions are reversible. But even if only 30% of the liver functions, you can live on by eliminating dangerous factors – alcohol, excess weight, drugs and hepatitis

Pain in the gallbladder, concomitant symptoms, treatment

This site is made by experts: toxicologists, narcologists, hepatologists. Strictly scientific. It is checked up experimentally.

The author of this article, expert: gastroenterologist Daniela Sergeevna Purgina

In short: The causes of pain in the gallbladder can be different: from organ bending to cancer. Therefore, the first thing you need to see a doctor to make a diagnosis and determine the treatment. In addition to drugs for gallbladder pathologies, a diet is always prescribed.

• First signs of malfunction of the body
• When the gallbladder can hurt
• Biliary dyskinesia
• Cholecystitis: how to recognize the disease?
• Inflection of the gallbladder – what is it?
• Parasitic infestations. How to notice?
• Gallstone disease: what to look for?
• Cancer: what are the manifestations?
• How to treat pain in the gallbladder?
• Why does it hurt after gallbladder removal?

This article was edited by gastroenterologist Daniela Sergeevna Purgina.

The fact that any part of the body can hurt is not news to people; but few people know how to understand what exactly hurts him inside. For example, not many people know that not only the intestines or stomach, but also the liver capsule, pancreas or even the gallbladder can hurt in the abdomen. But with the bladder, as with any other organ, unpleasant changes can occur that require the attention of doctors.

The first signs of an organ malfunction

Even before pain appears in the right side (where the gallbladder is located and hurts), a person should pay attention to such signs as:

• irritability and frequent mood changes ;
• general malaise;
• sleep problems, and at the same time constant drowsiness;
• headaches;
• unpleasant bitter or sour taste in the mouth;
• stool disorders;
• digestive problems, especially after eating fatty foods;
• loss of appetite;
• sudden weight loss;
• bloating;
• increased body temperature and blood pressure;
• excessive sweating;
• vomiting that does not get better, etc.

If any of these signs persist for more than three days, then this is a serious reason to consult a doctor. And if after the onset of such symptoms the gallbladder hurts, even more so.

Expert of Pokhmelye.rf website, gastroenterologist Daniela Purgina dispels a common misconception.

If the right side hurts, does it mean that the gallbladder necessarily hurts? And here it is not. The intestines can also hurt, and pain can also occur due to the pathology of the musculoskeletal system (“lower rib pain syndrome”), which requires a consultation with a neurologist.

When can the gallbladder hurt?

The final diagnosis can only be made by a doctor after conducting the necessary tests, however, by the nature of the pain and the accompanying symptoms, it can be assumed in advance which disease affected the gallbladder. Let’s talk about the most common pathologies in more detail.

Biliary dyskinesia

Weak muscle tone leads to the fact that the motor ability of the gallbladder deteriorates. Because of this, bile stagnates, and the digestion process is disturbed.

Dyskinesia can be caused by:

• sedentary lifestyle;
• malnutrition;
• hormonal failures.

Pregnant women often suffer from this disease. By the way, it is impossible to say exactly how the gallbladder hurts in women: everything will depend on age, weight, lifestyle and disease. But in men, attacks of aching pain are most common, which usually last no more than 20 minutes.

You may suspect that you have dyskinesia if you have acute pain under the ribs on the right side, which:

• comes on in fits during body movement,
• and after eating fatty or spicy foods.

For more information about why this disease occurs and how this disease manifests itself, as well as how to treat it, read the article about biliary dyskinesia.

Expert of Pokhmelye.rf website, gastroenterologist Daniela Purgina recalls.

Do not forget that diseases of the gastrointestinal tract can be not only organic, but also functional. That is, the bladder can hurt not only because of the presence of stones or inflammation in it, but also because its motor activity can be disturbed, while ultrasound and blood tests will not reveal any pathology.

Cholecystitis: how to recognize the disease?

Cholecystitis is an inflammatory disease in which the mucous membrane of an organ swells, which interferes with the outflow of bile. This condition of the gallbladder does not allow the digestive system to work properly. Both malnutrition and a sedentary lifestyle, as well as various diseases of the gastrointestinal tract, lead to cholecystitis.

There are two main types of cholecystitis:

1. Chronic. It proceeds almost asymptomatically, it is often detected by chance, during an ultrasound scan.
2. Sharp. It is characterized by constant aching pain in the right side, which intensifies after drinking alcohol, carbonated drinks and fatty foods. Sometimes the pain may move to the right shoulder, collarbone or scapula.

Associated symptoms may include:

• vomiting with bile;
• gradual increase in temperature up to 38 degrees.

Read more about the dangers of this disease and how to treat it, whether surgery is needed and whether herbal decoctions help, read the article about calculous cholecystitis.

Inflection of the gallbladder – what is it?

This pathology can be earned by a wrong way of life or regular hard physical labor, and also get it in the womb, so it will be difficult to name all the reasons for the appearance of an inflection. Because of it, some parts of the walls of the gallbladder thicken, which can lead to improper outflow of bile.

The inflection is rarely distinguished by special symptoms, usually it is just a pulling pain in the gallbladder, that is, in the right hypochondrium, which either appears or disappears. The inflection is either corrected surgically or goes away on its own: here you just need to follow a diet and observe.

Drawing pain in the gallbladder may occur due to the bending of this organ.

About the cases in which this pathology needs to be treated, how to detect it and what to do when the organ is deformed in children, read the article about the inflection of the gallbladder.

Parasitic infestations. How to notice?

There are many diseases that are caused by parasites. But when the gallbladder is affected, the symptoms are usually the same:

• pain under the ribs on the right;
• diarrhea;
• itching;
• elevated body temperature;
• rapid weight loss.

Children are most often affected by parasitic diseases, so pay special attention to such symptoms if the child complains of well-being.

Cholelithiasis: what to pay attention to?

When metabolism is disturbed in the gallbladder, salts accumulate. Therefore, it will not be difficult to answer the question of why the gallbladder hurts in this situation. Due to the stagnation of salt, sand first begins to form, and then stones form from it: this happens because the sand is not completely removed from the bubble on its own and continues to accumulate. Stones can be of different sizes and quantities, so for a long time the patient may not even know about their formation.

Aching pain in the right side appears only when there are too many stones or one grows so large that the gallbladder cannot hold such a weight in itself and begins to be damaged. The mucosa is injured, inflammation begins. This may additionally lead to:

• digestive and stool disorders;
• bitterness in the mouth;
• yellow staining of the skin.

Gallstone disease can cause pain in the gallbladder.

Sometimes pebbles can come out on their own, and if they are small, then this does not bring much discomfort. If the stone is large, then there is a sharp pain at the border with the small intestine, that is, on the right, closer to the stomach. At the same time, the state of health deteriorates sharply, and such a problem can only be solved surgically.

Cancer: what are the manifestations?

Unfortunately, oncology does not have any special symptoms: pain in the right hypochondrium, nausea, vomiting and digestive problems are also characteristic of other diseases of the gallbladder.

However, it is worth paying attention to exactly how the gallbladder hurts. When the pains intensify and become constant, it is no longer possible to eat, move and even breathe normally because of them. This condition usually occurs due to a rapidly growing tumor. But this is not a signal to start worrying, but to see a doctor as soon as possible: at this stage, treatment is still possible.

When a tumor develops, the gallbladder usually hurts in the evening and at night, at these moments it becomes painful to cough and take a deep breath.

How to treat pain in the gallbladder?

Treatment is not prescribed immediately, it still needs to be diagnosed. This is done on the basis of the results of the following analyzes and studies:

• blood test;
• ultrasound;
• x-ray;
• duodenal sounding;
• MRI and CT;
• biopsy – only if oncology is suspected.

An expert of the Pokhmelye.rf website, gastroenterologist Daniela Purgina warns against a common mistake.

If you experience pain, do not do tubage at home and do not start taking choleretic drugs, because this can aggravate the situation. Without an ultrasound examination, it is highly recommended not to take any drugs other than antispasmodics. Because in the presence of cholelithiasis, taking choleretic drugs can provoke the movement of stones, which is highly undesirable. And in the presence of inflammation, the use of a warm heating pad on the right side can enhance the inflammatory process.

Usually all diseases of the gallbladder are treated with medication. Depending on the diagnosis, the doctor may prescribe medications such as:

• choleretics – drugs that increase the content of bile acid in the bile itself;
• cholekinetics are drugs that cause the gallbladder to release accumulated bile;
• cholagogues and herbs;
• antibiotics are sometimes prescribed if an inflammatory process is detected.

Diet is always prescribed for pathologies of the gallbladder. It excludes fatty and spicy foods, fatty meats and alcohol.

If drug therapy has not helped or for some reason it cannot be carried out, then the patient may be prescribed laparoscopy: one of the most minimally invasive operations of all existing, during which the gallbladder is removed.

Folk remedies cannot cure gallbladder diseases on their own. However, they can serve their purpose as aids to:

• better absorption of medicines;
• relieve pain and relieve other symptoms;
• body recovery after treatment.

Take traditional medicines only on the recommendation of your doctor! They need to be chosen correctly so that the constituent substances do not come into conflict with the ingredients of the drugs, so that they are not contraindicated in your condition, and so on. Therefore, the only answer that can be given to the question: “What to do if the gallbladder hurts?” is to contact a specialist, and as soon as possible.

Advice to those who are ill from gastroenterologist Daniela Purgina, an expert on the Pokhmelye.rf website.

If you experience pain in the right hypochondrium, you can independently take any antispasmodic (drotaverine, papaverine, mebeverine, etc.) to relieve pain, limit the intake of fatty and fried foods (because it increases pain), and then consult a doctor to find out reasons and appropriate treatment. If the pain is intense and contributes to a decrease in performance, it is recommended to seek medical help immediately.

Why does it hurt after gallbladder removal?

There are cases when the operation has already been completed, but still after the removal of the gallbladder it hurts in the stomach. If the pains are not strong and appear from time to time, then there is nothing to worry about: this is a restructuring of the digestive system. There is no gallbladder, so now the organs fill the vacated space.

Pain can also occur due to the fact that bile is no longer stored in the bladder, but immediately flows into the duodenum (in a lower concentration).