Gallbladder And Gallstones Disease And Lab Testing

The gallbladder is a pear-shaped, small organ in your abdomen under the liver. In between meals, the gallbladder gathers bile and stores it. This digestive fluid is made inside the liver. It contains bile salts as well as other substances to help with digesting fat from food. During meals, the gallbladder contracts and then bile is released into the small intestine to help with digestion.

Bile ducts are thin tubes that transport bile from the gallbladder and liver into the intestines and include the following:  

  • Common bile duct 
  • Hepatic duct 
  • Cystic duct  

The gallbladder, in addition to the bile ducts that connect it to the small intestine and liver, is referred to as the biliary system. Also, the common bile duct runs through the top part of the pancreas, transporting bile into the small intestine from the gallbladder and liver. The pancreas is a flat, narrow organ with a tail, middle, and head section. The head section connects with the duodenum or first section of the small intestine. Digestive enzymes are carried by the pancreatic duct down the pancreas and then into the duodenum. Usually, the pancreatic duct and bile duct join right before the duodenum is entered and share the same opening to the small intestine.  

When the gallbladder isn’t functioning properly, gallbladder disease occurs. A majority of gallbladder problems happen when one a bile duct is blocked by a gallstone, which causes symptoms such as nausea and severe abdominal pain.   

Gallbladder disease also can develop when a blockage is caused by something else or with congenital defects, tumors, infections, or inflammation. A gallstone at times may block the pancreatic duct, which causes pancreatitis, or inflammation of the pancreas.  

Gallbladder Disease and Blockage  

Gallstones form when substances, like calcium salts, bile pigments, and/or cholesterol, harden into solid forms. Gallstone might be as big as a golf ball or as small as grains of sand.  

Gallstones affect 10% to 15% of adults in the U.S. under 65 years old and 20% of individuals who are older than 65 years old. Gallstones do not cause any symptoms most of the time. When the cystic duct is blocked by the gallstones, which leads to the bile duct, or the actual common bile duct, bile accumulates inside the gallbladder, which causes pain, swelling, and pressure. Pain that gallstones cause is referred to as biliary colic. Usually, it takes place in the upper abdomen or the back of the right shoulder blade sometimes within a short time period.  

Other types of gallbladder blockages: – Although the most common cause of gallbladder blockages are gallstones, other conditions may prevent bile from being able to move inside of the bile ducts They include the following:  

  • Biliary sludge – this occurs when bile stays too long inside the gallbladder. Microscopic bile particles may accumulate with stones forming. Eventually, the biliary sludge forms gallstones or passes into the biliary ducts and blocks them. Biliary sludge tends to form during pregnancy and normally disappears by itself.   
  • Viral infections – Gallbladder inflammation can trigger virial infections and cause the bile ducts to become scarred and inflamed, which can also cause the narrowing of the ducts. Before antiviral medications were widely available for treating HIV, 25% of individuals with HIV were affected by this gallbladder condition. Today, gallbladder disease caused by viral infection is reported only rarely in developed countries, although in developing countries, it is still a problem.   
  • Gallbladder cancer – this form of cancer is rare. For gallbladder cancer, the most common risk factor is gallstones. Since bile ducts can be blocked by a tumor, symptoms of gallbladder cancer are similar to the symptoms of gallstones. Bile ducts can also be blocked by cancers of the pancreas and non-cancerous tumors. 

Gallbladder inflammation (cholecystitis) 

Fortunately, uncomplicated gallbladder inflammation is quite treatable. However, if gallbladder inflammation is left untreated, it can become quite severe. It can result in a bacterial infection to develop, which can require the patient to receive antibiotics in the hospital. Severe, untreated inflammation may also result in sepsis, gangrene, gallbladder rupture, and pancreatitis.  

When a gallbladder blockage caused by gallstones or another type of obstruction persists, it may cause cholecystitis, which is gallbladder inflammation. 

Cholecystitis can develop very rapidly with a few hours (acute) or over a long time period (chronic). Acute cholecystitis begins suddenly and can cause severe pain within the upper abdomen and normally will last for over 6 hours.  

A person can rarely develop acute gallbladder inflammation with no evidence of any gallstone or another type of obstruction that blocks the bile duct. It is a serious condition referred to as acalculous cholecystitis. It may result in gangrene or a ruptured gallbladder. If left untreated, it can potentially be fatal.  

Typically, acalculous cholecystitis develops as a complication after a person is very ill already. It can affect individuals who are immune deficient, someone who has undergone extended intravenous feeding, has sepsis, severe burns, a serious injury, or has had major surgery. Sluggish bile movement can cause acalculous cholecystitis, which may be brought on in critically ill individuals by dehydration and fever.  

Ten percent of gallbladder inflammation cases are caused by acalculous cholecystitis, while the remainder is caused by gallstones:

  • Gallbladder pain but no gallstones  
  • People sometimes experience gallbladder pain without any obvious block of their bile duct. The pain may be caused by the following:  
  • Undetected small gallstones passing through the ducts 
  • The muscle in between the small intestines and bile duct not functioning 
  • A sensitive small intestine or biliary tract 

In some cases, it is not known why bile is not properly leaving the gallbladder  

Risk Factors 

The following are some of the most common risk factors for the development of gallbladder disease and gallstones:  

  • Older age (40 years old and older) 
  • Female Sex 
  • High blood cholesterol levels 
  • Obesity  
  • Mexican American or Native American descent  
  • Estrogen-containing medication treatment 
  • Rapid weight loss 
  • Family history of developing gallstones  
  • Liver disease 
  • Sickle cell anemia and other forms of hemolytic anemia  
  • Cystic fibrosis 
  • Diabetes 
  • Low fiber, high cholesterol, and/or high-fat diet  
  • Pregnancy 
  • Sedentary lifestyle  

Symptoms and Signs  

The most common cause of gallbladder disease is gallstone. However, most gallstones do not cause symptoms. Often they are discovered when an individual has an ultrasound or abdominal X-ray for evaluating a different issue.  

However, pain may experience inside the abdomen when a gallstone is blocking the bile flow outside of the gallbladder when it contracts. It is referred to as biliary colic. Symptoms and signs can include the following:  

Severe abdominal pain, particularly at the center or top ride side of the abdomen  

Nausea and abdominal pain occurring at the very same time 

Pain spreading to the right shoulder blade or back  

Abdominal pain linked when consuming a fatty meal (at the te the gallbladder contracts)  

The intense pain normally lasts for 30 minutes, at least but starts subsiding within one hour. Usually, a biliary colic attack lasts for under 6 hours.   

In certain cases, the cystic duct is permanently blocked by a gallstone, which results in gallbladder inflammation (acute cholecystitis). The pain is prolonged (normally more than 6 hours), unrelenting, and severe in acute cholecystitis. Typically a fever accompanies the pain.    

The stone can occasionally move from the gallbladder and inside the tube that transports bile into the intestine (referred to as the common bile duct). It may cause jaundice (yellow eyes and skin). You might also notice light-colored stool and dark urine. 

Acute cholangitis (inflammation of either the hepatic duct or the common bile) happens if bacteria enter into the blocked tube. That results in a high fever, often with extreme tiredness, vomiting, and pain.  

Gallstones may become lodge at the place where the common bile duct and pancreas meet. That results in pancreatitis (inflammation of the pancreas). Symptoms of gallbladder infection or inflammation that require a medical exam include:   

  • Whites of the eyes and yellowing of the skin (jaundice) 
  • Chills 
  • Fever 
  • Vomiting  
  • A gallbladder tumor blocking a bile duct may cause symptoms and signs that are similar to gallstones. A person who has gallstone cancer might also have:  
  • Greasy or light-colored stools 
  • Dark urine 
  • Weight loss 
  • Loss of appetite 
  • Itchy skin 
  • Lumps on the right side of the stomach  

Laboratory Tests 

Lab tests can be conducted to detect complications and determine the kind of gallbladder disease. Typically, people with uncomplicated gallbladder disease will have normal results on their lab tests.  

Some examples of lab tests that might be conducted when it is suspected that a person might have gallbladder disease include the following:  

Complete blood count (CBC) – this test evaluates the blood cells. When white blood cell counts are high, it can indicate a ruptured gallbladder, an abscess, infection, or inflammation.  

C-reactive protein (CRP -preferred test) or erythrocyte sedimentation rate (ESR) – elevated results are an indication of inflammation.  

Liver panel – if a person has gallstones blocking bile ducts, bilirubin results might be high because of bile backing up inside the liver.  In severe gallbladder inflammation cases, alkaline phosphatase (ALP) and other liver enzymes might be elevated.  

Amylase or lipase (preferred test) – these are pancreatic enzymes that might be elevated if pancreatitis has also been caused by gallbladder disease.