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

3.Types of Gallbladder problems

Gallstones

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.

4.Diagnosis of Gallbladder disease

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.

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)

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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