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

Today, we will be talking about gallbladder disease. But before we start, let’s know more about the gallbladder.

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

When we eat, signals are sent to the gallbladder. Then the gallbladder squeezes the stored bile into the small intestine through bile ducts. Bile is made to help digest the fatty meals, however, removing the gallbladder wouldn’t cause observable problems in a healthy person, only fat malabsorption or diarrhoea.

But what makes someone remove the gallbladder?

When there is a problem with the gallbladder, it is most probably removed.

Gallbladder disease is usually the main cause of removing it. Gallbladder disease includes inflammation, stones, infection, or even blockage of the gallbladder. It is a broad term that includes several types of conditions.

Any abnormality in the gallbladder flow of bile or any stone formation will cause inflammation of the gallbladder.

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

But what causes this inflammation or cholecystitis?

Gallbladder inflammation can be caused by many reasons including:

Gallstones. For unclear reasons, a substance in the bile that can crystalize, forms gallstones. Too much bile salts, cholesterol, or bilirubin in the bile can cause stones. These gallstones may be harmless, but they also may cause inflammation, pain, nausea, vomiting and blockage to the bile ducts. If they block the cystic duct where the bile flows out of the gallbladder, it leads to a buildup of the bile and consequently inflammation and infection. It can escalate to a life-threatening serious condition if left untreated. Gallstones have types including cholesterol stones, pigment stones, and mixed types.
Bile duct blockage. It could be due to bile stones, kinking or scarring of the bile ducts that also lead to a buildup of the bile and cholecystitis.
Gall bladder tumors. They can block the stream of the bile out of the gallbladder.
Infection. Some infections like AIDS may trigger cholecystitis.
Blood vessel disease. Any problem in the blood supply of the gallbladder will lead to functional problems, and gallbladder inflammation is one of them.

Inflammation of the gallbladder usually shows specific symptoms, but it depends on whether this inflammation is chronic or acute.

Either way, here are some of the most common symptoms associated with cholecystitis:

Severe pain in the center or the upper right part of the abdomen.
Pain that is referred to your right shoulder or your back.
Nausea.
Vomiting.
Fever.
Abdominal tenderness.
Abdominal cramps or bloating.
Chills.

These symptoms appear suddenly if the case is acute, or they develop slowly over the years if the case is chronic.

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

Jaundice is when your skin, mucous membranes, and the white of the eye are yellowish.

Symptoms particularly appear when the patient has a fatty meal. A typical attack will last from hours to three days. Patients shouldn’t experience all the symptoms; it will vary from one person to the other.

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

Serious complications of cholecystitis include:

Infection of the gallbladder. The buildup of bile inside the gallbladder may become infected and cause further inflammation and pain.
Perforation of the gallbladder. The swelling and infection of the gallbladder may lead to a cut off of the blood supply to the wall of the gallbladder. And if the wall of the gallbladder is dead, it would be easily torn or perforated.
Death, necrosis or gangrene of the gallbladder tissue. This is the most serious complication, especially in the older age group, patients who don’t get treated, and diabetic patients. It may eventually lead to perforation or burst of the gallbladder.
Pancreatitis. The backflow of the bile to the pancreas may cause digestion of the pancreatic tissue itself and severe inflammation.
Enlargement of the gallbladder. Due to swelling and inflammation, the gall bladder may be tender and enlarged that it can be felt on the abdominal wall.
Cancer of the gallbladder. This is a rare complication, but it takes a really long time to develop cancer of the gallbladder.

Now we know all about cholecystitis, let’s move 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 doesn't empty its contents completely or often enough. They can be very small as a sand grain or very large as a golf ball.

Here are some of the most common risk factors of gallstones:

Obesity.
Diabetes.
Old age, 60 years old or more.
Family history of gallstones.
Females are at higher risk.
Drugs that contain estrogen.
Liver cirrhosis or other liver diseases.

Another disease is choledocholithiasis. It is when gallstones block the bile ducts and thus gallbladder becomes enlarged and inflamed.

Choledocholithiasis will block the bile flow from the liver to the intestine and will cause:

Extreme pain in the center or upper right abdominal part.
Fever.
Chills.
Nausea.
Vomiting.
Jaundice.
Clay-colored stool.

Another strange disease of the gallbladder is Acalculous cholecystitis. It is the inflammation of the gallbladder without the presence of gallstones. It has been related to serious medical conditions or chronic illnesses. Some risk factors include:

Severe trauma.
Severe burns.
Heart surgery.
Abdominal surgery.
Autoimmune diseases like lupus.
Severe bacterial or viral illness.
Intravenous nutrition for long periods.

Its symptoms are similar to acute cholecystitis with stones.

Have you also heard about Biliary Dyskinesia?

It is one of the gallbladder diseases that occur when the gallbladder functions less than normal. It may be associated with ongoing gallbladder inflammation.

There are no gallstones with biliary dyskinesia, it is usually triggered by fatty meals. Symptoms include bloating, indigestion, nausea, and abdominal pain after eating.

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

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

As for gallbladder polyps, they represent abnormal growths that occur inside the gallbladder. They cause no symptoms and most often are benign. However, if a polyp is more than 1 cm, it is better to remove the whole gallbladder for fear of malignancy.

When the gallbladder becomes inflamed with pus, it is called a gallbladder abscess. Patients with gallbladder abscess complain of upper right abdominal pain, fever, and shaking chills. This condition can occur with acute cholecystitis when a stone blocks the gallbladder, and it becomes filled with white blood cells, bacteria, and dead tissue.

Another condition is gallbladder gangrene, and it is one of the most serious complications of acute cholecystitis that develops when there is not enough blood supply reaching the gallbladder. Patients usually come with a clinical picture of dull pain in the gallbladder region, fever, nausea, vomiting, low blood pressure, and disorientation. Males over 45 years old and diabetics are at greater risk of developing gangrene of the gallbladder.

Our last disease is gallbladder cancer. It is a rare disease in which malignant cells are found in the gallbladder tissue. Gallstones are a very common risk factor for developing cancer in the long run. Being a female increases the risk of gallbladder cancer. The vicious fact about that disease is that it is not discovered or diagnosed until late in the progression of the disease. Symptoms and signs of gallbladder cancer can be similar to acute cholecystitis. Also, there could be no symptoms at all. It can spread from the inner layer to the outer layer and then to the lymph nodes, liver and other organs silently. Oddly enough, gallbladder cancer can be discovered 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 role today is to answer most of your questions regarding gallbladder disease. Today we have Doctor Choi who is a renowned doctor at Hanyang University Hospital in Seoul, Korea. He is going to discuss gallbladder disease with us from an experienced point of view.

Interview:

Dr. Dong Ho Choi

How about gall bladder? Can you give us more details about gallbladder and its symptoms?

OK, gallbladder, called Damnang in Korean or Ssulgae…the most important role of this organ is the production of bile. Bile is made in the liver, then travels to the gallbladder for temporary storage. The most common problem is the development of stones. So, the gallstones hinder the storage and flow of bile, so the gallbladder becomes inflamed, and pain ensues, which is called cholelithiasis. This is one of the diseases, and in another, the gallbladder develops a polyp. If the polyp is left alone, it can morph into cancer, so we believe it is a condition that needs to be treated. Most notably, adenomatous polyps and gallbladder stones need to be removed via laparoscopic surgery. There is no other method to remedy the situation other than removal surgery.

We just talked about gallstone disease? What are the treatments for gallstone disease?

As I mentioned, long ago, medication was prescribed or administered locally in the affected area, but it was not meaningful as the gallstones developed yet again. So, nowadays, laparoscopic cholecystectomy surgery that does not take an hour is used to treat the condition, which is a relatively easy surgery. Of course, there is hesitation since it is the removal of the organ, but the fact that gallstones developed means it is not doing its job, so the best solution is the removal of the gallbladder.

Better than treatment, are there ways to prevent it from the beginning?

The most important is eating habits. The top reasons for developing gallstones are consuming fatty foods, another is in Korea long ago, seafood such as crustaceans and fish was consumed raw which sometimes ended in parasites causing infections which caused gallstones, which nowadays mostly disappeared. Lately the more common reason is consumption of fatty foods, which causes lots of gallstones, also getting fat also increases the chances for gallstones, with women often are more prone to getting gallstones when pregnant, so many reasons why gallstones develop and in general it is OK to leave as it is but if it causes pain or other symptoms, then the gallbladder needs to be removed. So, the most important way to reduce the chances of developing gallstones is controlling one’s eating habits.

We talked before about gallbladder, right? How about gallbladder cancer? What is the difference between gallbladder and gallbladder cancer?

Gallstones is a condition we see frequently, and if left untreated for a prolonged period, many morph into cancer. Because, if there are gallstones there is inflammation, and if left alone untreated for long it develops cancer. Not everyone turns to cancer, but if the stones are large or if the gallbladder is thickened or becomes fossilized, then even if there are no symptoms, we are recommended to remove the gallbladder because if left untreated it can turn to cancer. So, cancers tend to develop if the gallstones are left untreated for a long period. Even here I would say 10% to 20% probably have gallstones but show no symptoms. In such cases, for now it is OK but as they age and turn to 60 or 70, cancer may 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.

In the case of gallbladder cancer, there are no symptoms?

Most do not have symptoms. In cases where symptoms arise, usually are jaundice or pain but in such cases, it is already late. Even today, I operated on a patient who had no symptoms, but had cancer and had spread. So, periodic exams are key to prevent gallbladder cancer especially if there are issues, even if there is a small problem it is best to remove it before it becomes cancerous.

Is surgery the only way to treat it?

Yes. Especially in gallbladder cancer, chemotherapy is not effective. So, during the early stages quickly…there are two ways to arrive at cancer…due to polyps or stones in the gallbladder, in both cases if the gallbladder is quickly removed there is no chance of developing cancer. If not, one is continuously nurturing the disease. Then if the symptoms are seen later it is already too late. Then, a simple surgery may not work, and instead of just removing the gallbladder, parts of the liver may also need to be removed, gallbladder and other organs such as the duodenum… It becomes a huge surgical procedure, so it is best to do removal surgery fast.

My last question, professor…so I would go ahead and assume that the way of preventing gallbladder is the same as the way to prevent gallbladder cancer, right?

So, preventing gallbladder cancer is the same as preventing gallstones, but preventing gallstones is controlling eating habits to reduce the chances of gallstones. But that does not always mean cancer is prevented. For example, in Korea, 20% to 30% have some form of gallstones – for those people, a period exam to look out for enlarged gallbladder, or if the stones are increasing in numbers, or if the bladder becomes thickened, then if not removed earlier it can turn cancerous. So, to prevent cancer, frequent exams are needed if there are gallstones or polyps, removing the gallbladder early must be done to prevent cancer. If left alone, it can suddenly turn to cancer and there are no symptoms. Early detection and prompt removal is the best method for prevention of cancer.

Conclusion

The most important role of the gallbladder is the production of bile. Bile is made in the liver, then travels to the gallbladder for temporary storage. The most common problem is the development of stones. So, the gallstones hinder the storage and flow of bile, so the gallbladder becomes inflamed, and pain ensues, which is called cholelithiasis. Another ailment is the development of polyps. If polyps are left alone, cancer can develop, so we believe is a condition that needs to be treated. The most notably, adenomatous polyps and gallbladder stones, which need to be removed via laparoscopic surgery. There is no other method to remedy the situation other than removal surgery.

The most important prevention is eating habits. The top reasons for developing gallstones are consuming fatty foods, another is in Korea long ago, seafood such as crustaceans and fish was consumed raw which sometimes ended in parasites causing infections which caused gallstones, which nowadays mostly disappeared. Lately the more common reason is consumption of fatty foods, which causes lots of gallstones, also getting fat also increases the chances for gallstones, with women often are more prone to getting gallstones when pregnant, so many reasons why gallstones develop and in general it is OK to leave as is but if it causes pain or other symptoms, then the gallbladder needs to be removed. So, the most important way to reduce the chances of developing gallstones is controlling one’s eating habits.

While most do not have symptoms, some may have jaundice or pain but, in such cases, it is already late. So, periodic exams are key to prevent gallbladder cancer.