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Gallstones and other Gallbladder diseases:
Understanding Prevention, Treatment and Diagnosis

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1.Gallbladder function and importance

The Gallbladder is a small pouch like organ that stores the bile that is produced by the liver. The digestive fluid, also referred to as gall is required for the digestion of fats in food. Produced by the liver, the digestive fluid flows through little vessels into the larger internal organ ducts and ultimately through the cystic duct (parts of the biliary tree) into the bladder, where it is stored.

At any one time, 30 to 60 milliliters of bile is stored within the gallbladder. When food containing fat enters the canal, it stimulates the secretion of cholecystokinin (CCK) from I cells of the small intestine and small intestine. In response to cholecystokinin, the bladder rhythmically contracts and releases its contents into the common canal, eventually exhausting into the small intestine. The bile emulsifies fats in partly digested food, thereby assisting their absorption. Bile consists primarily of water and digestive fluid salts, and also acts as a means of eliminating bilirubin, a product of hemoglobin metabolism, from the body.

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2.Warning signs of Gallbladder problems

Gallbladder conditions share similar symptoms. These include:

Pain

The most common symptom of a gallbladder problem is a sharp pain in the mid- to upper-right section of your abdomen. It will be delicate and intermittent, or it can be quite severe and frequent. In some cases, the pain will begin to radiate to different areas of the body, as well as the rear and chest.

Nausea or vomiting

Nausea and physiological reactions are common symptoms of all kinds of bladder issues. However, solely chronic bladder illness might cause biological process issues, such as acid reflux and gas.

Fever or chills

Chills or an unexplained fever might signal that you may suffer from some degree of gall bladder infection. If you have got an infection, you need treatment before it worsens and becomes dangerous.

Chronic diarrhea

If your bowel movements are constantly erratic and excessive for more than three months, this could also be proof of chronic bladder illness.

Jaundice

Yellow-tinted skin, or jaundice, is also a symbol of gallstones or block within the common channel. The common channel is the channel that leads from the bladder to the little gut.

Unusual stools or urine

Lighter-colored stools and dark urine are also symptomatic of gallbladder problems.

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3.Types of Gallbladder problems

Gallstones

Gallstones treatment

Gallstones develop when substances in the bile (such as cholesterol, bile salts, and calcium) or substances from the blood (like bilirubin) form hard particles that block the passageways to the gallbladder and bile ducts. Gallstones also tend to form when the gallbladder doesn’t empty completely or often enough. They can be as tiny as a grain of sand or as massive as a golf ball.

Numerous factors contribute to your risk of gallstones. These include:

  • Being overweight or obese
  • Having diabetes
  • Being age 60 or older
  • Taking medications that contain estrogen
  • Having a family history of gallstones
  • Being female
  • Having Crohn’s disease and other conditions that affect how nutrients are absorbed
  • Having cirrhosis or other liver diseases

Cholecystitis

Cholecystitis is the most common kind of gallbladder disease. It presents itself as either acute or chronic inflammation of the bladder.

Acute cholecystitis

Acute cholecystitis is generally caused by gallstones but it may also be the result of tumors or various other illnesses. It may present as a pain within the upper right portion or upper-middle portion of the abdomen. The pain tends to occur right after a meal and ranges from sharp pangs to dull aches that can radiate to your right shoulder. Acute cholecystitis can also cause:

  • fever
  • nausea
  • vomiting
  • jaundice

Chronic cholecystitis

After many attacks of acute inflammation, the gallbladder can shrink and lose its ability to store and release bile. Abdominal pain, nausea, and vomiting may occur. Bladder surgery is often needed in treatment for chronic cholecystitis.

Choledocholithiasis

Gallstones might become lodged within the neck of the bladder or the digestive fluid ducts. When the gallbladder is blocked in this way, the bile can’t exit. This may be because the bladder becomes inflamed or distended. The obstructed digestive fluid ducts can stall digestive fluid from traveling from the liver to the intestines.

Choledocholithiasis can cause:

  • extreme pain in the middle of your upper abdomen
  • fever
  • chills
  • nausea
  • vomiting
  • jaundice
  • pale or clay-colored stools

Acalculous gallbladder disease

Acalculous bladder disease is an inflammation of the bladder that happens in the absence of gallstones formation. Having a significant chronic illness or serious medical condition has been shown to trigger this disease.

Symptoms are similar to acute cholecystitis with gallstones.

Some risk factors for the condition include:

  • severe physical trauma
  • heart surgery
  • abdominal surgery
  • severe burns
  • autoimmune conditions like lupus
  • bloodstream infections
  • receiving nutrition intravenously (IV)
  • significant bacterial or viral illnesses

Biliary dyskinesia

It is a disorder of the gallbladder where the motility of the gallbladder may be affected. In such a scenario, the bile is unable to move in the right direction through the biliary tract. It usually presents itself as pain in the upper right quadrant of the abdomen as well as nausea, bloating, and indigestion.

Your doctor may need to use a test called a HIDA scan to help diagnose this condition. This test measures the gallbladder function. If the gallbladder can only release 35 to 40 percent of its contents or less, then biliary dyskinesia is usually diagnosed.

Sclerosing cholangitis

Ongoing inflammation and damage to the bile duct system can lead to scarring. This condition is referred to as sclerosing cholangitis. However, it’s unknown what exactly causes this disease. Nearly half the people with this condition don’t have symptoms. If symptoms do occur, they can include:

  • fever
  • jaundice
  • itching
  • upper abdominal discomfort.

Approximately 60 to 80 percent of people who suffer from this condition also have ulcerative colitis. Currently, the only known cure for it is a liver transplant.

Gallbladder cancer

Cancer of the Gallbladder is a comparatively rare kind of cancer, they can be difficult to treat because they’re not often diagnosed until late in the disease’s progression. Gallstones are a standard risk factor for bladder cancer. The cancer typically spreads from the inner walls of the bladder to the outer layers then it spreads to the liver, lymph nodes, and other organs. The symptoms of gallbladder cancer may be similar to those of acute cholecystitis.

Gallbladder polyps

Gallbladder polyps refers lesions or growths that occur at intervals the bladder. They’re usually benign and have no symptoms. However, it’s often recommended to have the gallbladder removed for polyps larger than 1 centimeter. They have a greater chance of being cancerous.

Gangrene of the gallbladder

Gangrene can occur when the gallbladder develops inadequate blood flow. This is one of the most serious complications of acute cholecystitis.

Factors that increase the risk of this complication include:

  • being male and over 45 years old
  • having diabetes

The symptoms of gallbladder gangrene can include:

  • dull pain in the gallbladder region
  • fever
  • nausea or vomiting
  • disorientation
  • low blood pressure

Abscess of the gallbladder

The abscess of the bladder results once the bladder becomes inflamed with pus. Pus is the accumulation of white blood cells, dead tissue, and microorganisms. Symptoms may include upper right-sided pain in the abdomen along with fever and shaking chills. This condition can occur during acute cholecystitis when a gallstone blocks the gallbladder completely, allowing the gallbladder to fill with pus. It’s more common in people with diabetes and heart disease.

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4.Diagnosis of Gallbladder disease

Gallbladder disease diagnosis

To diagnose bladder problems, your doctor will look at your case history and perform an abdominal exam. This will include checking for pain within the abdomen. One or more of the following tests and procedures may be used:

Detailed medical history

A list of symptoms you’re experiencing and any personal or family history of gallbladder disease is important. A general health assessment may also be performed to determine if there are any signs of long-term gallbladder disease.

Physical exam

Your doctor might physically examine abdominal passage looking for what’s noted as “Murphy’s sign.” During this test, your doctor will put their hand on your abdomen over the area of the gallbladder. They’ll then ask you to take a breath while examining and feeling the area. If you're feeling sharp or stabbing pain, it suggests you may have gallbladder disease.

Ultrasound

An ultrasound uses sound waves to produce images inside your body. An ultrasound will inspect the bladder for the presence of gallstones, thickened walls, polyps, or masses.

HIDA scan

A HIDA scan is often used when a person has gallbladder symptoms but the ultrasound is inconclusive. This test can evaluate the function of the gallbladder using a harmless radioactive substance. The substance is injected into a vein and then watched as it moves through the gallbladder. Another chemical might also be injected that causes the bladder to unleash digestive fluid. A HIDA scan shows how the bladder moves digestive fluid through the channel system. It may check speed of digestive fluid moving out of the bladder. This is known as the ejection fraction.

Other tests

Other imaging tests, such as a CT and MRI scan, can also be used. Blood tests are also done to check for increased white blood cell counts and abnormal liver function.

Endoscopic retrograde cholangiopancreatography (ERCP) is a more invasive but useful test. A flexible camera is inserted into the mouth and down past the stomach into the small intestine. Contrast dye is injected to show the bile duct system with a specialized X-ray. ERCP is an especially useful test if a blockage due to gallstones is suspected. Any gallstone that is causing blockage can often be removed during this procedure.

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5.Gall bladder treatments and surgery

Lifestyle changes

Since certain health conditions increase the risk of gallstone formation, changes in lifestyle may help manage gallbladder disease in people without symptoms. Being overweight and having a polygenic disorder will increase the probability of gallstones. Losing weight and getting good control over diabetes may help lower your risk. However, speedy weight loss may also trigger concretion formation. Talk to your doctor regarding safe ways. Increasing physical activity additionally seems to decrease concretion formation together with lowering high triglycerides, a type of fat in the blood. It’s often recommended to quit smoking and limit alcohol intake as well.

Medical treatment

The first episode of gallbladder inflammation is often treated with pain medications. Because the pain is often severe, prescription medications are needed. Your doctor may prescribe medications with codeine or hydrocodone. IV prescription anti-inflammatories may be prescribed or stronger pain medications like morphine.

Over-the-counter medications like ibuprofen (Advil) and naproxen (Aleve) may not be used as often due to the increased risk of nausea and vomiting. If you’re dehydrated, anti-inflammatory drugs may also cause severe kidney issues. Most people have difficulty managing the pain and its accompanying symptoms at home.

Surgery

Surgery is generally recommended to get rid of your bladder problems if you suffer from multiple episodes of inflammation. Gallbladder surgery continues to be the foremost effective technique for treating bladder problems. The surgery can be done either by opening your abdomen with an incision, or laparoscopically. This involves making several minute holes through the abdominal wall and inserting a camera. Laparoscopic surgery allows for faster recovery.

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6.Risks and long term complications

After gallbladder surgery by either method, it’s not uncommon for people to experience some diarrhea. Up to 3 out of 10 people can have diarrhea after gallbladder surgery. For most people, diarrhea will only last a few weeks. But in a few cases, it can last for years.

If diarrhea is continuing after surgery for more than two weeks, talk to your doctor. Depending on other symptoms, you may require follow-up testing.

The gallbladder may form an abnormal passageway, or fistula between the gallbladder and the intestine to help process the liver’s bile. This is most often a complication of chronic inflammation related to gallstones.

Acute cholecystitis

When a concretion blocks the duct wherever digestive fluid moves from the bladder, it can cause inflammation and infection in the gallbladder. This is known as acute cholecystitis. It is a medical emergency. The risk of developing acute cholecystitis from symptomatic gallstones is 1 to 3 percent.

Symptoms associated with acute cholecystitis include:

  • intense pain in the upper abdomen or mid-right back
  • fever
  • chills
  • appetite loss
  • nausea and vomiting

See a doctor straight away if these symptoms last over one to two hours or if you've got a fever.

Other complications

Untreated gallstones may cause complications such as:

  • jaundice, a yellowish tint to your skin or eyes
  • cholecystitis, a gallbladder infection
  • cholangitis, a bile duct infection
  • sepsis, a blood infection
  • pancreas inflammation
  • gallbladder cancer
  • obstruction of the intestine
  • inflammation and scarring
  • perforation (a hole in the gallbladder)
  • bacterial contamination of the abdomen, known as peritonitis
  • malignant transformation (the change cells undergo to become a cancerous tumor)

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7.Prevention of Gallbladder disease

Certain risk factors for gallbladder disease, such as sex and age, can’t be changed. However, your diet may play a role in developing gallstones. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), foods high in fiber and healthy fats may help prevent gallstones.

Refined grains (found in syrupy cereals and polished rice, bread, and pasta) and syrupy sweets square measure related to a better risk of bladder sickness. Whole grains like brown rice and whole wheat bread and fats from fish and olive oil are all recommended.

The earlier gallbladder problems are recognized and treated, the less likely significant complications will occur. It’s important to talk to your doctor if you’re experiencing any signs or symptoms of gallbladder disease.

Foods to avoid

To help improve your condition and cut back your risk of gallstones, strive these tips:

  • Reduce your intake of fats and choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods.
  • Add fiber to your diet to make your bowel movements more solid.
  • Try to add solely a serving of fiber at a time to stop gas which will occur from intake excess fiber.
  • Avoid foods and drinks known to cause diarrhea, including caffeinated drinks, high-fat dairy products, and very sweet foods.
  • Eat several small meals per day. Smaller meals are easier for the body to digest.
  • Drink a sufficient amount of water. This is about 6 to 8 glasses per day.
  • If you propose to reduce weight, do it gradually.

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8.Road to Recovery and Aftercare

Common post-operative guidelines for Bladder surgery are:

  • You will need someone to drive you home after you are released as the anesthesia may make you feel groggy and tired
  • Do not take away the dressing over the incision for the primary 2 days and keep the realm clean and dry.
  • No showering or bathing during this time. The incision usually heals in about 5 days
  • Your doctor might provide you with activity restrictions like no work.
  • You must follow your surgeon's instructions for a successful recovery
    • You may feel soreness around the incision area. Your surgeon may give you prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable
    • If the stomach was distended with gas, you may experience discomfort in the stomach, chest, or shoulder area for a couple of days while the excess gas is being absorbed

Diet

You must be very careful with your diet after gallstone removal as your body will not be able to digest fats well. It is recommended to stick to a liquid diet for a week or two and then introduce solids back into your diet. When you do so, you have to stick to a low-fat diet. Stay away from fried foods and gas-forming foods. Keep away from spicy foods to avoid stomach bloating and abdominal pains.

Exercise

Gallbladder removal, like any surgery, requires recovery time. Typical rest time when major abdominal surgery is six weeks, throughout that strenuous exercise ought to be avoided. Consult your doctor before starting any exercise routine when your bladder surgery.

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9.Gallbladder disease FAQs: All your concerns addressed

Q.   What Are the Symptoms of Gallstones?

  1. Severe pain within the higher right abdomen and probably extending to the higher back.
  • Fever and shivering.
  • Severe nausea and vomiting.
  • Jaundice (yellowing of the skin or eyes)
  • Clay-colored stools or dark urine.

Q.   What are the signs of a failing gallbladder?

  1. Some of the major signs that you have a failing gallbladder include-
  • Intense and sharp pain in the mid/upper right section of the abdomen-
  • Mostly, gallbladder pain will come and go. But, gallbladder pain can oscillate between mild, irregular, to severe. When the gallbladder issues are left untreated it can lead to frequent pain. The episodes will radiate through the chest and back.
  • Vomiting or nausea-
  • If you have any gallbladder issues, it will show up as nausea and vomiting. Long-term gallbladder diseases will lead to digestive problems that will cause frequent nausea.
  • Fever-
  • Fever and chills are major signs of an infection in the body. This symptom will surface if the gallbladder problems have escalated into an infection.
  • Change in bowel movement pattern-
  • A failing gallbladder will usually result in a change in bowel movements. This includes sudden diarrhea, along with light chalky stools, which points to problems inthe bile ducts.
  • Change in urine-
  • Patients who are experiencing issues with their gallbladder will notice dark urine, which can signal a block in the bile duct.
  • Jaundice
  • When the liver bile doesn’t reach the intestines, it can lead to yellowing of the skin. This will signal a filing gallbladder due to a blockage in the bile ducts that is caused by gallstones.

Q.   Can gallstones kill you?

  1. Acute cholecystitis is not usually a medical emergency. However, in the later stages it could lead to death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection.

Q.   Is alcohol bad for gallstones?

  1. Currently, no research shows any direct link that alcohol contributes to gallbladder problems including gallstones. However, if your liver is impaired leading to imbalanced bile, this can increase your chances of contracting gall stones.

Q.   Can gallstones cause liver damage?

  1. Most commonly, gallstones can cause an obstruction of the ducts that drain bile from the liver. Abnormalities of the gap of the digestive juice epithelial duct into the little gut (sphincter of Oddi) will result in abnormalities of bile flow and hence could damage the liver.

Q.   Can gallstones come back after the gallbladder is removed?

  1. Sometimes, stones could also be left behind once the removal of the bladder (cholecystectomy). Typically, they are found within 3 years after a person has undergone the procedure. Recurrent gallstones continue to develop within the bile ducts after the gallbladder has been removed.

Q.   What can I expect after Gallbladder removal?

  1. It's attainable you may expertise organic process facet effects once your bladder is removed.
  • Difficulty digesting fat. It may take your body time to regulate to its new methodology of digesting fat.
  • Diarrhea and flatulence.
  • Constipation.
  • Intestinal injury.
  • Jaundice or fever.

Q.   What are the long term side effects of gallbladder removal?

  1. Difficulty digesting fatty foods.
  • Temporary diarrhea.
  • Chronic diarrhea.
  • Temporary constipation.
  • Retained stone in a bile duct.
  • Intestinal injury.

Q.   Can having your gallbladder removed cause you to lose weight?

  1. After surgery, you may have some trouble digesting fatty foods until your body adjusts this might cause weight loss.

Q.   When should you see a doctor for your gallbladder?

  1. Any patient who is experiencing gallbladder issues must seek medical attention immediately. Mild or intermittent pain that does not go away completely needs immediate attention. Ensure that you make an appointment with your doctor so that the problem can be examined further. If the symptoms include severe nausea, fever, and vomiting, it can indicate serious infection and inflammation that will need immediate treatment.

Q.   Are gallstones a sign of cancer?

  1. Gallstones are a common symptom and risk factor for bladder cancer. Hence it’s essential to go for cancer screening if you’re suffering from gallstones.

Q.   Can gallstones go away without surgery?

  1. There is a chance that gallstones may disappear on their own, but generally, that doesn’t happen and treatment is necessary. Gallstones can occur without causing any symptoms as well, and in such cases, making changes in the diet is all that may be required to avoid any further complications.
  2. However, your doctor will recommend you to stay alert for any symptoms of gallstone complications. Sometimes, the symptoms may surface as an intensifying pain in the upper right abdomen. You have to identify these signs and symptoms and get yourself treated.

Q.   Are gallstones dangerous?

  1. Gallstones can be dangerous as they can lead to serious infections and damage to the gallbladder, liver, and pancreas if left untreated. Life-threatening conditions may also occur if damage to these organs is severe enough to hinder their normal functions.

Q.   How long does gallbladder surgery take?

  1. The gallbladder is removed by a surgical procedure called a cholecystectomy. It is a common surgery that doesn’t have many risks of complications. Usually, the patient can go home on the same day as their cholecystectomy, but they may have to stay one or more nights in the hospital to manage any complications that can occur within that time.

Q.   What happens after gallbladder removal?

  1. The gallbladder stores bile produced by the liver in between meals. After its removal, the bile won’t be stored anymore. It will instead directly flow into the intestine whenever the liver makes it. Although the amount of bile is reduced now, it’s still enough to help digest and transfer the fat from the intestine into the body.
  2. A small category of people may experience softer and frequent stools after the removal of the gallbladder, but the changes are often temporary. It’s still better to discuss everything with your doctor.

Q.   Do I need to change my diet after gallbladder surgery?

  1. After the removal of the gallbladder, most people don’t have to bring major changes in their diets. You may be asked to follow a special diet before the surgery, but you don’t have to continue it afterward. Some people do experience indigestion, bloating and diarrhoea after surgery, but this usually improves within a few weeks.
  2. If you notice that the consumption of certain food or drink triggers these symptoms, you must avoid them in the future. Besides, you should aim to have a balanced and healthy diet in general.

Q.   What kind of diet helps with gallbladder health?

  1. Doctors usually think that a low-fat diet can help with treating gallstones or at least prevent them from growing. But, new studies have proved that drastic weight loss can lead to an increase in gallstone size, instead of shrinking them.
  2. To avoid this, you must include different types of foods that will not only prevent gallstones but also help in maintaining the overall health and will aid in keeping any gallstone pain under control. However, you must inform your doctor of any pain that may be caused due to gallbladder issues. Doctors, with the help of nutritionists and dieticians, can help you come up with a diet plan that’s suitable for you. Your diet will normally include high fiber foods, such as beans, fruits, peas, whole grains, and vegetables; this also includes reducing carbohydrate and sugar intake. Additionally,you should consume healthy fats like fish oil and olive oil.

Q.   When to Seek Medical Care for Gallstones?

  1. Seeking medical care for gallstones is necessary if a person is experiencing ongoing or recurring episodes of abdominal pain 30 minutes to one hour after meals. Emergency care may be required if the person has abdominal pain along with any of the following conditions:
  • over-the-counter pain medications don’t work to control the abdominal pain
  • Chronic diarrhea.
  • the person has fever, chills, sweats, or begins to vomit
  • the person has jaundice

Q.   Are there any non-surgical treatments for gallstones?

  1. Non-surgical treatments for gallstones are performed in situations where the patient has a serious medical condition that prevents surgery. Even after it is treated, there is a possibility that gallstones may return. So, people with gallstones may have to be treated regularly for a very long time or for the rest of their life.
  2. The following non-surgical treatments are used by doctors to remove or break up gallstones.
  • Endoscopic retrograde cholangiopancreatography or ERCP is a non-surgical treatment used to remove a gallstone stuck in the bile duct.
  • Oral dissolution therapy uses medicines like ursodiol NID external link (Actigall) and chenodiol NIH external link (Chenix) to break up gallstones. This treatment is effective only when the cholesterol stones are small. So, it may take months or years of treatment to break up all the stones.
  • Shock wave lithotripsy: This treatment method is used to blast gallstones into small pieces for easy removal. The procedure is rarely used and sometimes along with ursodiol.

Q.   What is the diagnosis process for gallbladder issues?

  1. If a doctor suspects that the patient has a gallbladder issue, then they will order the following tests-
  • Imaging- Imaging tests for gallbladder include ultrasound and CT scans that used to image the gallbladder. These are commonly used for gallstones.
  • Tests to examine blocked bile ducts- These tests make use of dyes to identifya gallstone that is causing a blockage in the bile ducts. The tests include anMRI, HIDA scans, and ERCP.

Q.   How do you treat gallstones naturally?

  1. Although medicines and surgical options can effectively manage gallbladder issues, people turn to natural remedies as well for gallstones treatment. Reliable evidence about the effectiveness of natural alternatives is yet to be found. Some of the popular methods are as follows.
  • To cleanse the gallbladder, a blend of apple juice, olive oil, and herbs is consumed for two to five days.
  • People drink dandelion teas to eliminate their gallstones.
  • Milk thistle has been used for centuries to detoxify the liver.
  • Lysimachiae herba or gold coin grass is a well-known Chinese remedy for removing gallstones.
  • Artichoke extracts are used to help in gallbladder function and stimulate bile production
  • Some yoga poses to help relieve gallstones are Bhujangasana, Dhanurasana, Pachimotasana, Sarvangasana, and Shalabhasana.

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