If you have been diagnosed with a low-functioning gallbladder, or with gallstones, this is technically a form of "gallbladder disease".
There are specific diagnoses for various problems, but the symptoms are common to them all.
See each separate diagnosis or disease described below for more details.
Whatever form of gallbladder disease you have, it is important to figure out the underlying cause or causes. A thorough understanding of this will help you to manage your gallbladder problem. You can do this by carefully studying the causes of gallbladder disease.
Specific Gallbladder Diseases
Bile reflux, just as it sounds, is similar to acid reflux but in this case it is caused by the upward flow of bile from the duodenum of the small intestine into the stomach and the esophagus. The pyloric sphincter is a valve at the base of the stomach that opens to allow the passage of food into the small intestine. It is also supposed to keep food and bile acids from backflowing into the stomach.
The symptoms of bile reflux are similar to the burning pain of heartburn but also may include nausea and vomiting of bile. Weight loss may also be an accompanying symptom. Treatment often includes antacids, which are only partially helpful. The fact that antacids do not relieve symptoms is often diagnostic of bile reflux. Drugs that bind bile salts are generally more effective. Left untreated, bile reflux can cause gastritis, ulcers and possibly stomach cancer.
Causes of Bile Reflux
Bile reflux can be caused by gallbladder surgery, but is more often a result of gastric surgery. The pyloric valve can also be obstructed by scar tissue or by an ulcer.
Biliary Dyskinesia - Also Known as Low-Functioning Gallbladder
Biliary dyskinesia is called by many names, including acalculous cholecystopathy, which means disease or condition of the gallbladder without the presence of gallstones. It may also be referred to as functional gallbladder disorder or impaired gallbladder emptying. The diagnosis of this under-functioning gallbladder is determined by the measure of a 32% or lower ejection rate from the gallbladder.
Symptoms of Biliary Dyskinesia
Right upper quadrant pain (in the absence of gallstones) may be felt by a patient with low-functioning gallbladder. Any gallbladder symptoms may accompany this problem as it results in lack of concentrated bile from the gallbladder to digest fats.
Causes of Biliary Dyskinesia
- chronic inflammation
- problem with the smooth muscles of the gallbladder
- the muscle of the Sphincter of Oddi being too tight
Biliary Hyperkinesia – Hyperactive or Hyperkinetic Gallbladder
A gallbladder condition without stones as well, a hyperkinetic gallbladder is diagnosed by a 65% or higher ejection fraction via a HIDA scan.
Symptoms of Biliary Hyperkinesia
The symptoms are similar to that of a low-functioning gallbladder with right, upper-quadrant pain and any other symptoms of other gallbladder disease. However, in this case there might be spasms of the gallbladder and more likelihood of diarrhea due to the excessive flow of bile.
Causes of Biliary Hyperkinesia
Very little is known about this condition but one theory for the underlying cause is an overactive vagus nerve with stress being an additional contributing factor.
Cholangitis is inflammation of the bile duct itself. Chole = bile and angi = duct.
Symptoms of Cholangitis
- jaundice or yellowing of the skin and eyes
- abdominal pain
Causes of Cholangitis
Acute cholangitis is usually caused a bacterial infection resulting from stagnation of the bile in the duct. Choledocholithiasis, a gallstone that gets stuck or lodged in the bile duct, can create an obstruction that results in an infection. Less frequently, infections can evolve due to a stricture or narrowing of the duct itself such as in Primary Sclerosing Cholangitis. Infections may accompany a cancer. Something blocks the free flow of the bile causing a stagnant condition which allows the bacteria to take hold. Medical procedures can also be a causative factor.
Primary Sclerosing Cholangitis or PSC
PSC is a disease in which the bile ducts from the liver become hardened and eventually obstruct the flow of bile. It is characterized by inflammation, breaking down of and eventual hardening of or fibrosis of the bile ducts within the liver and outside the liver (both intrahepatic and extrahepatic bile ducts.) It is most likely an autoimmune liver disease.
This is a very serious disease which requires medical intervention, which often includes putting in a stent to help the bile to flow freely. As an adjunct, consider castor oil packs without heat to help with reducing inflammation and improving lymph flow.
Symptoms of Primary Sclerosing Cholangitis
- itching (caused by bile backing up into the blood stream)
- jaundice (yellowing also caused by backflow of bile into bloodstream)
- tenderness in upper abdomen caused by inflammation to the ducts (cholangitis)
- possible fever and chills.
Cholecystitis is the inflammation of the gallbladder.
Causes of Cholecystitis
Acute cholecystitis is nearly always due to an irritation from gallstones but may be due to bacterial infection as well.
Chronic cholecystitis occurs with or without stones (acalculous cholecystitis is without). With or without stones present, the medical treatment generally recommended is gallbladder removal.
Choledocholithiasis – Gallstones in the Bile Ducts
Choledocholithiasis is a stone or stones stuck in one of the bile ducts. This condition can be very painful and is the common cause of a gallbladder attack, but is technically called a gallstone attack when outside the gallbladder.
Symptoms of Choledocholithiasis
Symptoms for choledocholithiasis may differ depending on where the stone is and if it is blocking bile flow. It can block the neck of the gallbladder by lodging there or in the cystic duct, causing distention and inflammation (cholecystitis). In the common bile duct, it can cause a backing up of bile into the liver resulting in obstructive jaundice or into the pancreas causing acute pancreatitis.
Cholelithiasis – Gallstones
Solid crystalline precipitates in the biliary tract, usually formed in the gallbladder. Gallstones, derived from the bile, consist mainly of calcium, cholesterol, or bilirubin. Since gallstones are the most common gallbladder disease, there is a separate page dedicated to a discussion on Gallstones.
Cholestasis is the impairment of bile flow due to obstruction in small bile ducts within the liver (intrahepatic cholestasis) or obstruction in large bile ducts outside the liver (extrahepatic cholestasis) such as the common bile duct. Disorders of the pancreas can also cause cholestasis.
Symptoms of Cholestasis
Blocking of the secretion of bile results in the bile backing up into the circulation. This may result in jaundice and excess bilirubin in the blood which would make the urine dark and the stools pale or chalk colored. The excess of bile salts in the systemic circulation may cause intense itching and skin irritation. There may also be dark urine and/or fat in the stools.
According to The American Cancer Society, there were approximately 11,740 new cases of gallbladder/large bile duct cancer in the year 2017 alone. Statistics show that it occurs 5x as often in Native American people in New Mexico than in whites. Women are more susceptible than men.
There are rarely any symptoms with gallbladder cancer early on. In fact, it is often only discovered when the gallbladder is removed for other causes such as gallstones. Otherwise, gallbladder cancer is often quite advanced by the time it is diagnosed. If caught early, removing the gallbladder and affected tissues in bile ducts is the standard treatment.
Gallbladder polyps are growths that protrude from the lining of the gallbladder. They're usually innocuous and rarely cancerous (malignant). 95% are non-cancerous. 10% are the result of inflammation. Most polyps are the result of cholesterol deposits.
Gallbladder polyps are usually asymptomatic and need no treatment. They may be found incidentally on an ultrasound of the gallbladder done for some other reason. There is rarely pain involved and any pain that is there is most likely due to something else such as gallstones. Occasionally, they may grow large enough to require surgical removal.
Porcelain gallbladder is the calcification or encrustation of the gallbladder wall. It gets the name "porcelain" from its blue color and brittle wall. A porcelain gallbladder is not a very frequent occurrence. However, gallbladder cancer is a risk for this condition. Removal is the treatment of choice.