About 20 million people in the United States (15% of the entire population) suffer from gallstones. It’s estimated that gallbladder disease accounts for 1.8 million healthcare visits every year accumulating about 6.5 billion dollars annually in healthcare costs (1).
Lifestyle factors including diet and physical activity levels are responsible for the majority of these conditions so many are suffering from today.
What Does the Gallbladder Do?
Your gallbladder is an organ that stores a green liquid substance called bile, which helps your body to digest fat. Bile is made by your liver. It is mostly composed of cholesterol, bilirubin, bile salts, and water.
When you’re digesting food, your gallbladder releases stored bile into the small intestine through a tube called the common bile duct.
The gallbladder is a small organ about the size of a lemon that lives under your liver. So it is located in your right upper abdomen, just under your right ribs. The liver, gallbladder and bile ducts all make up your biliary tract.
Gallbladder Pain Location
If your gallbladder is causing problems, it makes sense that you would feel pain in the right upper part of your abdomen. Sometimes this pain is also radiates elsewhere.
- right upper abdomen
- upper middle abdomen
- right mid back
- right flank
- right shoulder
When bile contains too much cholesterol or too much bilirubin, it can develop into a thicker fluid called biliary sludge. It can also harden further and turn into pebble like stones that form in the gallbladder. These are also referred to as gallstones, and the medical term for having gallstones is cholelithiasis.
Gallstones can be made mainly of bilirubin, cholesterol or both. It’s estimated that 85% of the population with gallstones in the United States are cholesterol stones (1).
Many people that have gallstones don’t experience pain, and may not even know that they are there.
However, gallstones frequently cause problems. Gallstones can block the common bile duct that allows bile to drain from the gallbladder. When this happens bile builds up, and can cause these individuals to experience a lot of pain in what some call a gallbladder attack. The medical term for gallstone pain that isn’t associated with any other complications is called biliary colic.
Most commonly this involves sharp right upper abdominal pain that is often associated with nausea and/or vomiting. Uncomplicated gallstone symptoms usually go away after a few hours.
People with gallstones can suffer from:
- Abdominal Pain
- Nausea and Vomiting
- Right Shoulder Pain
- Mid Back or Right Flank Pain
- Jaundice (Yellow Skin)
- White Stools
- Fevers & Chills
Eating food - especially fatty foods - is the most commonly trigger for gallstone symptoms.
What Causes Gallstones?
The risk of gallstones is most strongly based in lifestyle choices. People who eat a diet high in saturated fat and who are obese have an increased risk for these complications.
- Diet (high in saturated fat & high in calories & low in fiber)
- High Cholesterol
- Overweight & Obesity
- Metabolic Syndrome
- Fast Weight Loss
- Long Fasting Periods
- Some Medication (specifically for hypercholesterolemia)
- Liver Disease (ie: liver cirrhosis & hepatitis C & non-alcoholic fatty liver disease)
Non-Preventable Risk Factors
- Older Age
- Ethnicity (Native Americans & Hispanics are at a higher risk)
- Family History
- Hemolytic Disease (ie: sickle cell disease)
Gallstones can cause many complications in addition to the pain experienced with biliary colic.
- Biliary Colic
- Gallstone Pancreatitis
- Cancer (very rare)
The most common complication of gallstones is cholecystitis. Cholecystitis is an infection and inflammation of the gallbladder.
Types of cholecystitis include:
1. Acute Cholecystitis
Gallbladder inflammation and infection that occurs over hours to a day, usually caused by gallstones.
2. Acalculous Cholecystitis
Gallbladder inflammation without a gallstone or physical obstruction present. It is usually accompanied by other chronic diseases or serious illness.
3. Chronic Cholecystitis
Gallbladder inflammation and damage due to repeated attacks of biliary colic (gallstone pain).
People with cholecystitis often experience the symptoms of gallstones most frequently including abdominal pain, nausea and vomiting. However they also have symptoms associated with an infection. This usually includes a fever and in severe cases can also lead to symptoms of severe infection(aka sepsis) including fast heart rate and low blood pressure.
How to Know if You Have Cholecystitis
Besides learning about your symptoms and performing a physical exam, your doctor may perform many tests to diagnose cholecystitis.
Blood tests can often show if there are signs of infection (WBC) and liver function tests (LFTs) can often tell if the gallstone is causing liver problems.
Inflammation that is characteristic of cholecystitis is usually able to be seen by your doctor by using an ultrasound. A CT scan is also sometimes used.
When it’s difficult to tell if there is a gallbladder infection, a HIDA scan may be used. HIDA scan’s work by injecting a radioactive tracer into the bloodstream and using a nuclear medicine scanner to look very closely at the biliary tract when the tracer reaches it.
A HIDA scan provides a lot of inflammation and is painless.
Other Gallbladder Problems
Other problems can arise from gallstones.
When a gallstone gets stuck in the common bile duct draining the bile, it can completely obstruct it’s flow. This is called choledocholithiasis. This can be a very dangerous condition.
If a gallstone gets stuck and blocks the pancreas, it can cause inflammation of the pancreas called pancreatitis. This causes significant abdominal pain, nausea and vomiting and can lead to other dangerous complications.
While relatively rare, gallbladder cancer can develop in about 5,000 people per year in the United States. It is a serious cancer and can be deadly. Cholelithiasis and cholecystitis put people at an increased risk for developing cancer. Other risk factors for cancer include obesity, a poor diet, biliary abnormalities, older age, and other chronic inflammatory conditions (1, 4)
There are a couple of treatment options for gallstones. Prevention is always the best option.
Even if you already have gallstones, weight loss, eating the right diet and increasing your physical activity can help to prevent future gallstones - and their complications from occurring.
Thankfully we don’t need our gallbladder to function, and when it causes problems the organ can be cut out.
Gallbladder removal is almost always recommended in cases of cholecystitis (infected gallbladder). People who frequently suffer from recurrent bouts of gallstone pain (cholelithiasis) may also choose to have it removed.
This surgery is performed all of the time and is called a cholecystectomy. In fact there are about 700,000 cholecystectomies performed every year in the United States (1).
The most common approach to surgery is called laparoscopic cholecystectomy. The surgeon uses a small tube that allows them to look inside the abdomen and remove the gallbladder. This approach often leads to much smaller cuts that cause less pain and often heal well with less obvious scars.
Shock wave therapy, also called lithotripsy, is another treatment option that avoids surgery. It may be an option for about 20% of people suffering from gallstones (5). This is particularly good for people with small gallstones who have an otherwise functioning gallbladder.
This method creates shock waves from high energy sound waves that break up the gallstones.
In some cases, doctors may provide medication to treat gallstones. These work to help dissolve gallstones and prevent them from forming.
Other Gallstone Treatment Options
Sometimes if surgery is too dangerous, other options may be utilized. These include putting a stent around the gallstone to allow flow. There is also an option to put a tube in the gallbladder to allow it to drain.
Preventing Gallbladder Disease
Gallbladder problems can often be prevented by the right lifestyle choices including regular exercise, healthy weight management, and the right diet.
The National Institute of Diabetes and Digestive and Kidney Diseases recommends some basic dieting principles (6).
- High fiber diet
- Include healthy unsaturated fats
- Minimize unsaturated fats (ie: fried foods)
- Minimize added sugar
- Minimize refined carbohydrates
Incorporating these choices in a calorie controlled meal plan, along with physical activity to help with weight loss is the ideal approach to both prevention and treatment for gallbladder disease.