What makes your gallbladder go bad: Cholecystitis – Symptoms and causes

02.06.202208.06.2023 by alexxlab

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What Are Common Gallbladder Problems? Symptoms, Causes, Diagnosis, Treatment, and Prevention

By Quinn PhillipsMedically Reviewed by Ira Daniel Breite, MD

Reviewed: January 4, 2023

Medically Reviewed

Your gallbladder is one of those organs that you probably don’t think too much about — unless something goes wrong.

Its main function is to store bile, which helps the body break down and digest the fats that you eat. It doesn’t produce the bile — the liver does that and sends it into your small intestine via the common bile duct during meals. As the small intestine does its job, most bile travels to the gallbladder, where it is stored until needed again. Then, when you eat fatty foods, your gallbladder releases the bile into the small intestine, where it’s mixed with partially digested food. (1)

Gallbladder problems are usually due to a blockage in your bile ducts, the tubes that let bile travel between your liver, gallbladder, and small intestine. The most common source of blockage is gallstones (cholelithiasis), which develop when substances in bile crystallize. (2)

Signs and Symptoms of Gallbladder Problems

If you have gallstones or another problem with your gallbladder, you may develop abdominal pain that can range from mild to excruciating. These attacks can last from 30 minutes to several hours. (3)

The gallbladder is located in the right upper area of your abdomen. “If there are any problems, typically the person complains of pain in that location, right below the ribs,” explains Tomasz Rogula, MD, PhD, president of the International Bariatric Club and a professor of surgery at the Jagiellonian University in Poland.

If a gallstone completely blocks the flow of bile to the gallbladder or small intestine, you may experience the following symptoms, in addition to pain:

Nausea or loss of appetite
Fatigue
Weight loss
Jaundice (yellowing of the skin and eyes)
Fever and chills
Itching
Night sweats
Dark urine
Greasy or light-colored stools (4)

Gallstones may never cause any pain at all, and may be discovered by chance on an imaging scan performed for unrelated reasons. In that case, no further treatment is necessary. (3)

While gallbladder and bile duct symptoms are most frequently caused by gallstones, other illnesses, including pancreatic and gallbladder cancer, can also be a factor.

Gallbladder cancer usually doesn’t cause any symptoms until its later stages. Even then, the symptoms overlap with those of other gallbladder problems, so it can be hard to identify. (5)

There can also be noncancerous growths that form on the lining of the gallbladder, known as polyps (only a small percentage of them are cancerous). These polyps usually do not cause any symptoms, but rarely may cause the following:

Nausea
Vomiting
Periodic pain in the upper-right abdomen (6)

Learn More About Symptoms of a Gallbladder Problem

Common Questions & Answers

Is having a gallbladder necessary?

The gallbladder’s primary function is to store bile, which is produced in the liver and helps break down fats in the body. People can function without a gallbladder if the organ needs to be removed. The body copes by filling bile ducts, which transport bile to the small intestine, and using them to store excess bile.

What are the symptoms of gallstones?

Gallstones form from hardened bile and cholesterol and can block the release of bile from the gallbladder. This can lead to severe pain, particularly after a large or fatty meal, jaundice (yellowing of the skin and eyes), fever, and chills.

What complications can arise from gallbladder removal?

Severe complications from gallbladder removal are rare. The digestive system may be disrupted for a period of time, but this is expected. In rare cases, more serious complications can develop, including bile leaking into the abdominal cavity, injury to a bile duct, and attacks of pain in the area. Infection, blood clots, and scarring can also occur. Even without a gallbladder, some people still make stones, which can lodge in and obstruct the bile ducts.

What diet changes are necessary after gallbladder removal?

The body needs time to adjust to losing its storage area for bile after gallbladder removal. As a result, it can be difficult to digest fatty and high-fiber foods. It’s best to slowly reintroduce these foods after the surgery. Eating smaller meals more frequently may also be helpful, to reduce the demand for bile at any given time. Over time, the vast majority of people resume a normal diet.

Causes and Risk Factors of Gallbladder Problems

It’s often unclear exactly why gallstones form, but there are a number of factors that increase your risk of developing them, including the following:

Being a woman
Older age
Obesity
High cholesterol
Taking medications that contain estrogen
Losing weight quickly
Diabetes
Pregnancy

Risk factors for gallbladder cancer — an uncommon cause of bile duct blockage — include the following:

Being a woman
Older age
History of gallstones
History of other gallbladder problems, such as polyps or infection (5)

The main known risk factor for gallbladder polyps is a family history of the condition. Gallbladder polyps aren’t more common in particular genders, age ranges, body weights, or with a history of other health conditions. (6)

One ongoing area of research is the role of the gallbladder microbiome — the bacteria that live in and around the organ — in gallstones and other gallbladder problems. One study found that the bacteria Helicobacter and Salmonella may contribute to gallstone formation. (7)

How Are Gallbladder Problems Diagnosed?

To diagnose a gallbladder problem, such as gallstones, your doctor will first ask about your symptoms and perform a physical examination to determine what area of your abdomen is tender or painful. (3)

If your doctor suspects gallstones, you may undergo one or more of the following tests:

Blood Tests Your doctor may look for elevated bilirubin, a waste product in blood that can signal a blocked bile duct. Tests may also look for abnormal pancreatic or liver enzyme levels, or signs of infection. An elevated level of alkaline phosphatase can also indicate a bile duct obstruction.

Abdominal Ultrasound This noninvasive test uses sound waves to view your gallbladder and surrounding areas, including any gallstones that may be present.

Abdominal CT Scan This noninvasive test uses radiation to create images of your gallbladder and bile ducts.

If a more detailed look at your gallbladder and bile ducts is needed, your doctor may schedule the following procedures:

Magnetic Resonance Cholangiopancreatography An MRCP is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas, and pancreatic duct.

Endoscopic Retrograde Cholangiopancreatography If the MRCP reveals blockages, an ERCP procedure may be used to remove it. In this procedure, you are sedated and an endoscope (a long, thin tube) containing a tiny camera is passed down your throat into your bile ducts to remove stones. (4)

Diagnosing Gallbladder Cancer

Gallbladder cancer is rare, but when it does occur, it’s usually not discovered until it has spread beyond the gallbladder.

Your doctor will diagnose gallbladder cancer on the basis of blood tests, imaging tests, a physical exam, and your history of symptoms.

Once gallbladder cancer is confirmed or suspected, more tests will be needed to determine the extent (stage) of your cancer. These may include:

Further imaging tests
ERCP or other endoscopic procedures
Exploratory laparoscopic surgery (using a small incision and camera) (5)

Diagnosing Gallbladder Polyps

Gallbladder polyps are usually discovered only when your doctor is looking at your gallbladder and bile ducts for another condition. If your polyps are causing symptoms, your doctor may order an abdominal ultrasound to look at the area.

If you have polyps that are less than 5 millimeters (mm) wide, your doctor may decide that no further exploration is needed, since these are unlikely to be cancerous. But any polyp of 10 mm or more will require additional follow-up. (6)

Prognosis of Gallbladder Problems

Some gallbladder problems may cause only minor, occasional discomfort, while others may lead to serious and even life-threatening health problems. While the overwhelming majority of people with gallstones are asymptomatic and do not immediately require treatment, gallstone symptoms generally tend to be progressive and eventually require intervention.

Your doctor will determine the type and severity of your gallbladder problem and come up with a treatment strategy. Many gallbladder problems improve or are even completely resolved with treatment. (2,3)

Learn More About How Gallbladder Problems Are Diagnosed

Duration of Gallbladder Problems

Gallbladder problems may be persistent, causing bouts of pain and other symptoms indefinitely if the underlying condition is not treated. It’s important to see a doctor for diagnosis and treatment if you experience any signs or symptoms of gallbladder problems.

Treatment and Medication Options for Gallbladder Problems

If you have a gallstone that is blocking your common bile duct (the one that runs from the gallbladder to the small intestine), your doctor may recommend endoscopic retrograde cholangiopancreatography (ERCP). This procedure may be used both to diagnose your condition and to treat it immediately.

During ERCP, an endoscope (a long, thin tube) containing a tiny camera is passed down your throat and into your bile ducts. Your doctor may then use additional tubes or tiny tools to remove gallstones from the area.

If you have gallbladder cancer, in addition to having your gallbladder removed, your doctor may recommend additional treatments such as chemotherapy or radiation therapy. (5)

Doctors are also learning more about how and when to treat gallstones during pregnancy. Recent research has shown that while most pregnant women with symptomatic gallstones don’t undergo gallbladder surgery during pregnancy, having the operation is associated with an almost 60 percent lower risk of hospital readmission (and gallstones during pregnancy increase the risks of preterm birth and health problems in both mothers and newborn babies). (8)

Gallbladder Surgery

The most common surgical procedure related to the gallbladder is removing it completely. Known as cholecystectomy, gallbladder removal is most often performed to resolve pain caused by gallstones.

There are two methods of gallbladder removal. Laparoscopy, which is almost always the preferred method, involves making several small incisions through which surgical tools and a tiny video camera are inserted.

Open surgery, using a large incision, may be required if your surgeon discovers during a laparoscopic procedure that your gallbladder is infected or has hardened. This happens in 5 to 10 percent of laparoscopic gallbladder surgeries. (9) Open surgery may also be the first choice if your gallbladder disease is severe. (4)

Learn More About Gallbladder Surgery

Medication Options

Medications may be used to help reverse gallstones, but usually only when surgery isn’t an option. A drug called ursodiol may be taken to slowly dissolve the cholesterol in gallstones. But this treatment can take months, and gallstones may return once the drug is no longer being taken. (3)

Alternative and Complementary Therapies

Dietary changes are often recommended following gallbladder surgery.

When your gallbladder is removed, your body is no longer able to store bile there. As a result, your liver must adapt to releasing bile directly into your small intestine to aid in digestion. Before your body adapts to this new reality, it can be more difficult to digest certain fatty and high-fiber foods.

It’s best to reintroduce those kinds of harder-to-digest foods slowly after your surgery, rather than jump back into your normal diet. It may also be helpful to eat smaller meals more frequently, since this reduces your small intestine’s demand for bile at any given time. (10)

Learn More About Your Diet After Gallbladder Removal

Prevention of Gallbladder Problems

While there’s no proven way to prevent gallstones, there are some steps that may be helpful, including:

Eating three balanced meals each day
Maintaining a healthy weight
Getting regular exercise
Drinking alcohol in moderation (9,11)

It’s also important to manage any health conditions that may raise your risk of developing gallstones, including diabetes and high cholesterol.

Complications of Gallbladder Problems

Gallstones can lead to a number of different complications in the gallbladder and beyond, including the following:

Cholecystitis (inflammation of the gallbladder), caused by a blockage in bile circulation
Blockage of the common bile duct
Cholangitis, when infected material is trapped in the common bile duct
Pancreatitis, due to gallstones blocking pancreatic enzymes from traveling to the small intestine (3,12)

These issues can be quite painful and cause fever, chills, or jaundice. Seek urgent medical attention if you develop these symptoms. (3)

Learn More About Cholecystitis

Complications of Gallbladder Surgery

Gallbladder removal is a common procedure that rarely results in severe complications. The surgery often causes a disruption in your digestive system for a period of time, but this is an expected side effect of the procedure and shouldn’t be alarming. (10)

You may also experience loose stools on occasion after gallbladder removal, caused by bile entering your small intestine when no food is present. This may be treated with a bile acid-binding medication. (9)

In some cases, though, more severe complications develop, such as bile leaking into the abdominal cavity or an injury to a bile duct, your liver, or your small intestine. These can occur on top of general surgery complications like infection, bleeding, blood clots, and pneumonia.

Contact your doctor if you experience any signs of a complication that may need treatment. (13)

Learn More About Gallbladder Surgery Complications

Research and Statistics: How Many People Have Gallbladder Problems?

More than 25 million people in the United States have gallstones, making them relatively common. It’s estimated that women make up 65 to 75 percent of this group. (9)

Before age 40, women are almost 3 times as likely to develop gallstones as men — in part because of the increased risk of gallstones during pregnancy. But by age 60, women have only a slightly higher risk. (9)

Gallbladder removal is one of the most common operations in the United States, performed over 600,000 times each year. (10,11)

Native and Hispanic Americans and Gallbladder Problems

Certain ethnic groups have a higher risk for gallbladder problems than others. In the United States, the risk for gallbladder cancer is highest for Native Americans than any other group. (14) Native Americans are also at a higher rate for gallbladder disease, as are Hispanic Americans, likely because of a combination of genetics, diet, and obesity rates. (15)

Resources We Love

Organizations for Essential Gallbladder Disease Information

American College of Gastroenterology

If your doctor suspects gallbladder disease, this is a good resource to start with. The web page is divided into questions about different aspects of the condition.

American Pediatric Surgical Association

This site is geared toward parents of children with gallbladder disease, but may be useful for people of any age or their caregivers. It offers a thorough and easy-to-understand explanation of how the gallbladder works and what can go wrong, diagnostic tests, treatment options, and recovery.

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

Surgery to remove the gallbladder is most often done laparoscopically, using small incisions and guided by a tiny camera. This resource explains the operation and other forms of surgery to remove a gallbladder.

Online Resource for Finding a Surgeon Who Specializes in Minimally Invasive Gallbladder Surgery

SAGES

Laparoscopic surgery to remove a gallbladder is commonly performed, but if your situation is not an emergency, this site can help you look for a surgeon near you with specific expertise in this procedure. Be sure to ask about their experience with open abdominal surgery in case it becomes necessary.

Online Resource for What to Eat After Gallbladder Surgery

Cleveland Clinic

This resource has specific suggestions for what to eat after gallbladder surgery as well as what foods to avoid.

Additional reporting by Diana Rodriguez.

Editorial Sources and Fact-Checking

How Does the Gallbladder Work? InformedHealth.org. September 6, 2018.
Gallbladder Diseases. MedlinePlus. July 14, 2016.
Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis. American College of Gastroenterology. July 2013.
Kidney Stones. Virginia Mason Franciscan Health.
Gallbladder Cancer. Mayo Clinic. July 8, 2022.
Gallbladder Polyps. Mercy Health.
Wang Y, Qi M, Qin C, Hong J. Role of the Biliary Microbiome in Gallstone Disease. Expert Review of Gastroenterology & Hepatology. May 3, 2018.
Ibiebele I, Schnitzler M, Nippita T, Ford JB. Outcomes of Gallstone Disease During Pregnancy: A Population-Based Data Linkage Study. Paediatric and Perinatal Epidemiology. September 7, 2017.
What to Do About Gallstones. Harvard Health Publishing. September 30, 2021.
What to Eat After You Have Your Gallbladder Removed. Cleveland Clinic. September 18, 2019.
Treatment for Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017.
Gallstones. Mayo Clinic. August 20, 2021.
Cholecystectomy (Gallbladder Removal). Mayo Clinic. September 18, 2021.
Castro FA, Koshiol J, Hsing AW, Devesa SS. Biliary Tract Cancer Incidence in the United States — Demographic and Temporal Variations by Anatomic Site. International Journal of Cancer. October 1, 2013.
Figueiredo JC, Haiman C, Porcel J, et al. Sex and Ethnic/Racial-Specific Risk Factors for Gallbladder Disease. BMC Gastroenterology. December 8, 2017.

Additional Resources

Siddique A, Kowdley KV. Approach to a Patient With Elevated Serum Alkaline Phosphatase. Clinics in Liver Disease. May 2012.
MRCP (MR Cholangiopancreatography). RadiologyInfo.org. April 15, 2022.

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The Gallbladder and Digestion

The gallbladder is a small organ that sits under your liver.

Its main function is to store, concentrate, and secrete bile, a liquid made by your liver that helps digest fatty foods. (3)

If you need to have surgery to remove your gallbladder, your liver will still produce enough bile for normal digestion. But instead of being stored in your gallbladder, bile will flow directly from your liver into your small intestine.

As your body adapts to this new reality, you might have some difficulty digesting certain foods in the days and weeks following gallbladder removal (also known as a cholecystectomy). (2)

Foods to Avoid After Gallbladder Surgery

While your body adjusts, it’s a good idea to avoid high-fat foods for a few weeks after your gallbladder removal.

High-fat foods include:

Fried foods, like french fries and potato chips
High-fat meats, such as bacon, bologna, sausage, ground beef, and ribs
High-fat dairy products, such as butter, cheese, ice cream, cream, whole milk, and sour cream
Pizza
Foods made with lard or butter
Creamy soups or sauces
Meat gravies
Chocolate
Oils, especially palm and coconut oil
Skin of chicken or turkey

Certain high-fiber and gas-producing foods can also cause discomfort after gallbladder surgery, so you may want to introduce them slowly back into your diet.

These foods include:

Whole-grain breads and cereals
Nuts
Seeds
Legumes
Brussels sprouts
Broccoli
Cauliflower
Cabbage (2)

You may benefit from including more soluble fiber in your diet, since it can help regulate bowel movements, according to the Mayo Clinic. Good sources of soluble fiber include oats and barley.

It’s a good idea to avoid larger meals after gallbladder surgery, since your body can no longer store as much bile as before. Smaller, more frequent meals may be easier to digest. (4)

How to Use a Food Diary to Help Manage Crohn’s Symptoms and Flares

To figure out what foods, if any, are causing problems after your surgery, you may want to consider keeping a food journal.

In this journal, you can record when you add foods back into your diet, as well as any digestive symptoms you’re experiencing — and possibly make a connection between the two. (2)

If you need help developing a diet plan after your surgery, ask your doctor to refer you to a registered dietitian.

Will a Gallbladder Cleanse Help?

The so-called gallbladder cleanse is often touted on social media as a treatment for gallstones or an alternative to gallbladder removal.

There are many different recipes for this “cleanse,” but most involve drinking large amounts of citrus juices, Epsom salts, and olive oil.

The advertised promises may sound enticing, especially if you’re facing the cost and hassle of gallbladder removal.

But there are no gallbladder flushes or cleanses that have been proven to break up or eliminate gallstones, says Sanjay Jagannath, MD, a gastroenterologist in Raleigh, North Carolina.

“There’s not any good evidence to suggest there’s anything out there to reliably do that,” Dr. Jagannath says.

Jagannath says that people who try out these remedies often have subsequent bowel movements that include small round objects thought to be gallstones.

But, he notes, the observed objects are actually the result of the olive oil mixing with bile, the fluid in the gallbladder that digests fat.

“Bile mixes with olive oil to form a yellowish-colored soap,” Jagannath says. “There are no real stones actually pushed out by the gallbladder in most cases.”

Jagannath adds that these objects usually float in the toilet, while real gallstones are hard — like pebbles — and sink to the bottom.

And you should be especially wary of any product marketed as an herbal gallbladder treatment. “The problem with all herbal treatments is there’s no regulation by the FDA [Food and Drug Administration],” Jagannath warns.

It’s always advisable to check with your doctor before trying any kind of over-the-counter treatment for gallbladder problems, he adds.

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