This blog was originally published in June, 2015.
A gallbladder attack can be a very painful, potentially dangerous medical condition. This article will help you understand the signs and symptoms of gallbladder attack—and how they can be prevented.
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What is the gallbladder?
The gallbladder is an organ in the right upper abdomen, just below the liver. It stores bile (also called gall), which is produced by the liver and used to digest fat from food. Bile is made up of water, cholesterol, bile salts, fats, proteins, and a compound called bilirubin. If bile contains too much cholesterol or bilirubin, it can harden into gallstones.
Most people with gallstones don’t even know that they have them. In some cases, a gallstone may cause the gallbladder to become inflamed, causing pain, infection, or other serious complications.
What is the purpose of the gallbladder?
While the stomach does a wonderful job of starting the digestion process, it doesn’t work alone. The small intestine, colon, and many other organs participate in turning food into nutrients the body can use. The gallbladder is one of the many organs that plays a part in the digestion process, but what exactly is the purpose of the gallbladder?
As mentioned above, the liver produces bile to help the small intestine break down fats from food, as well as fat-soluble vitamins such as A, D, E, and K. Bile also carries waste out of the body. The gallbladder releases bile during mealtimes to help the body digest fats. When the body is not actively digesting, such as overnight or between meals, the gallbladder stores bile.
Gallbladder Health Concerns
Problems with the gallbladder often arise when something blocks the normal flow of bile into and out of the gallbladder. Some of the most common issues include:
- Tumors/gallbladder cancer
- Cholecystitis (inflammation of the gallbladder)
- Gallbladder blockages (when gallstones cause gallbladder attacks)
Sometimes, doctors recommend gallbladder removal—especially in the case of severe, recurring gallstones that cause gallbladder attacks.
A gallbladder attack is a term commonly used to describe a gallstone blockage event.
Usually, bile acids and proteins prevent the formation of gallstones. But when there’s an imbalance in the bile components, pebble-like deposits known as gallstones are formed in the gallbladder. As gallstones block the bile ducts, pressure increases in the gallbladder. This can cause a temporary “attack” of pain in the center of the upper abdomen. This belly pain, called biliary colic, will radiate outwards, and may gradually move to the center of the belly or upper back.
A gallbladder attack or gallstone blockage can last anywhere from 15 minutes to a few hours. Gallstones are often managed by waiting for them to be naturally passed, but you should seek medication attention immediately if you’re experiencing severe pain. Sometimes, heart attacks and other serious health concerns are mistaken for gallbladder attacks.
Signs & Symptoms of a Gallbladder Attack
- Gallbladder pain. Pain in the upper right side or middle of the abdomen. The pain can be dull, sharp, or cramping. The pain usually starts suddenly. Feeling of pain is steady and may spread to the back or the area below the right shoulder blade. Having steady pain particularly after meals is a common symptom of gallbladder stones.
- Nausea. Nausea or vomiting are common symptoms of all types of gallbladder problems.
- Jaundice. Yellow-tinted skin or eyes may be a sign of a bile duct block from a gallstone.
Risk Factors for Gallstones
Certain factors can increase your risk of developing gallstones. Some of these factors (like your family history) can’t be changed, but others (like the foods you eat) can be adjusted to lower your risk.
- A family history of gallbladder disease or gallstones
- Being of Native American or Mexican descent
- Being over age 40
- Being clinically obese or overweight
- Eating a high-fat and/or high-cholesterol diet
- Eating a low-fiber diet
- Losing weight at a rapid rate (such as after gastric band surgery)
- Taking certain medications (including some cholesterol-lowering medications and drugs containing estrogen, like birth control pills or HRT)
Having any one of these risk factors increases your chance of developing gallstones. Being proactive about the risk factors under your control—especially your diet—can help reduce your chance of encounter problems.
How do you avoid gallstones?
Gallstones often occur when the substances in bile are out of balance. Too much bilirubin or cholesterol can cause gallstones to form. Not enough bile salts (which help your body process fat) can also lead to gallstones.
Not all gallstones can be prevented—but there are ways you can reduce your risk.
One study found that participants with a healthy diet had a lower risk of gallstone disease. Changing the foods you eat every day is an important part of preventing gallstones.
- Eat more dietary fiber. Fiber can help keep your cholesterol in check. Good sources of dietary fiber include fruits, veggies, and whole grain carbs.
- Switch to lean proteins. Fatty meats, like beef, sausages, and bacon, are high in saturated fats and can raise your cholesterol. Lean proteins, like chicken, turkey, and fish, are better for your gallbladder. Additionally, a study found that diets rich in vegetable protein (found in beans and tofu) was associated with a lower risk of gallstone disease.
- Lose weight slowly. Losing too much weight too quickly can increase your risk of gallstones. If your goal is to lose weight, have patience—crash diets and “lose fat fast” programs often come with a lot of other risks and often lead to weight regain.
Additionally, be sure to talk about your gallbladder health with your doctor. Your doctor can help monitor your cholesterol and help you determine what kind of lifestyle changes will work best for you.
A gallbladder infection most commonly occurs due to gallstone obstruction of one of the ducts that moves bile from the gallbladder to the intestine. Bacteria in the bile may lead to gallbladder gangrene, rupture, abscess, or a bloodstream infection.
Signs & Symptoms of Gallbladder Infection
Recognizing symptoms that may indicate a gallbladder infection is important, as this condition requires urgent medical treatment.
- Fever. Fever generally don’t occur with a typical gallbladder attack. Fevers are more common with infections. A sudden temperature spike in someone with gallbladder-related symptoms could indicate the development of gallbladder gangrene or rupture or the development of a bloodstream infection.
- Gallbladder pain. Gallbladder infection almost always causes severe pain, which usually begins in the right or middle upper abdomen. Over time, the pain increases in intensity and becomes more generalized, a characteristic that helps distinguish a gallbladder infection from a gallbladder attack. Gallbladder pain that lasts more than 6 hours points to the possibility of a gallbladder infection.
- Gastrointestinal disturbances. Abdominal distension (swelling/bloating of the stomach) due to decreased intestinal activity in response to a gallbladder infection or inflammation may also occur.
- Heart palpitations, rapid Breathing, and/or confusion. A racing heartbeat, rapid breathing and confusion are typical symptoms of shock, which may develop if a gallbladder infection spreads to the bloodstream.
Cholecystitis is the most common type of gallbladder disease. A common sign of cholecystitis may be either acute or chronic inflammation.
Acute cholecystitis comes on suddenly and is generally caused by gallstones, but may also be the result of tumors or various other illnesses. Acute cholecystitis will present with pain in the upper right side or upper middle part of the abdomen. The pain can come right after a meal and range from sharp pangs to dull aches that may often radiate to the right shoulder. Additional symptoms of acute cholecystitis include: fever nausea, vomiting, jaundice, and different colored stools.
Cholecystitis is considered chronic after several attacks of acute cholecystitis, the gallbladder will begin to shrink and lose its function of storing and releasing bile. Abdominal pain, nausea, and vomiting may follow.
How Gallbladder Disorders & Diseases are Diagnosed
- Blood tests help diagnose gallbladder disease. A complete blood count, or CBC, can help confirm an infection if there is a high white blood cell count. Other specific blood tests can also reveal high bilirubin levels (the cause of jaundice, a complication of gallbladder problems) or elevated enzymes suggesting an obstruction in the gallbladder.
- Urine tests may also be performed to help diagnose problems with the gallbladder by looking for abnormal levels of chemicals like amylase, which is an enzyme that aids in the digestion of carbohydrates, and lipase, another enzyme that helps break down fats.
- Ultrasound use sound waves to examine the bile ducts, liver and pancreas. It is not invasive and is very safe. Stones may be seen in the gallbladder or bile ducts.
- An endoscopic ultrasound involves using a special scope with an ultrasound probe on the end. The scope is passed down into the small intestines where internal ultrasound images of the bile ducts, gallbladder and pancreas can be obtained.
- CT scan are helpful in diagnosing cancers within the pancreas. It may identify gallstones but is not as effective in finding them as an ultrasound.
- ERCP (Endoscopic Retrograde Cholangiopancreatography) uses a special type of endoscope, which allows access to the bile ducts and pancreas ducts. It also allows therapy to be performed such as removing stones from the bile ducts or pancreas ducts.
- MRCP (Magnetic Resonance Cholangiopancreatography) is an imaging test using a machine called MRI (Magnetic Resonance Imaging). It is a noninvasive test that employs special computer software to create images of the bile and pancreatic ducts similar to the images obtained by ERCP and does not require an endoscopy.
Gallbladder Removal: What It Is & What You Should Know
If you have a gallbladder disease or severe gallstones, your gastroenterologist may recommend removing your gallbladder. The surgical removal of the gallbladder is called a cholecystectomy.
However, surgery isn’t for everyone with gallstones. Some people have “silent” gallstones, which means the stone don’t cause symptoms. In fact, they may be present for years and not discovered until an unrelated imaging tests uncovers them. As long as silent gallstones don’t cause symptoms, the gallbladder doesn’t need to be removed.
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Does my gallbladder need to be removed?
If you have gallbladder issues that are causing uncomfortable or dangerous symptoms, your doctor may recommend gallbladder removal surgery. Gallstones tend to recur in people who have attacks, so removal is sometimes the most effective way of preventing future attacks. You can live a normal lifestyle without a gallbladder, since bile has other paths to reach the small intestine.
When functioning normally, the gallbladder controls the distribution of bile, a fluid which helps the digestive system process fats. Bile is stored in the gallbladder when the body is not actively digesting, such as between meals or overnight, and released into the small intestine during mealtimes.
There are several conditions which can interrupt the normal flow of bile. When bile can’t flow normally, a person may feel symptoms such as pain, discomfort, nausea, and more.
Types of Gallbladder Removal Surgery
The type of gallbladder removal surgery you receive will depend on the source of the problem, the size of any gallstones, and how the gallbladder can safely be removed.
There are several types of gallbladder removal surgery, which is also known as a cholecystectomy.
Also known as ‘traditional’ or ‘conventional’ gallbladder removal surgery.
This procedure involves making an incision in the patient’s abdomen and the gallbladder is removed. Also known as ‘traditional’ or ‘conventional’ gallbladder removal surgery. Hospital stays usually average around a week, while recovery is estimated between four to six weeks.
- A long incision is made in the patient’s abdomen. The gallbladder is separated, sutures applied to cystic ducts and arteries, and the gallbladder removed.
- Patients can expect to stay in the hospital for up to a week after the operation.
- The average recovery time to return to normal work and activities is usually four to six weeks.
Open cholecystectomies used to be the most common type of gallbladder removal surgery, but laparoscopic cholecystectomy surgery has now become the standard for most cases.
Sometimes called ‘keyhole’ surgery due to the small incisions and use of a tiny video camera during the procedure. Multiple incisions are made in the patient’s abdomen and a specialized camera is used during the procedure. Hospital stays are usually less than 24 hours, and most patients can return to normal activities within two weeks.
- Several small incisions are made in the patient’s abdomen. As with open cholecystectomy, the gallbladder is separated, sutures applied, and the gallbladder removed.
- If for any reason the gallbladder is determined unsafe to remove by way of laparoscopic cholecystectomy, your surgeon will switch to open cholecystectomy.
- Since this procedure is less invasive, patients can usually leave the hospital within 24 hours of surgery.
- The average recovery time to return to normal work and activities is usually two weeks.
Your surgeon may perform a cholangiogram during LC to see if there are any gallstones in the bile duct. A cholangiogram is a test which identifies any gallstones which are located in the tubes and ducts outside of the gallbladder. A dye is injected into the bile duct to illuminate any stones. Then, an X-ray is taken. If any gallstones are located, they will be removed.
Laparoscopic cholecystectomy is not an option for everyone. People who have previous upper abdominal surgery or certain pre-existing health conditions may need an alternate treatment method.
LC is also not viable if the gallbladder is infected, extremely inflamed, or if the gallstones are very large.
Some people are unable to have surgery due to pre-existing medical conditions or prior surgery in the upper abdomen. In these cases, non-surgical treatments may be an option. These patients may have had prior abdominal surgery or other health conditions. Medication can be prescribed to dissolve cholesterol-based gallstones. Lithotripsy, or shock wave dissolution, is another way to dissolve cholesterol-based gallstones.
- Medication may be prescribed to dissolve cholesterol-based gallstones. However, it may take months or years for the gallstones to completely dissolve, and the stones may return at a later date.
- Shock wave dissolution, also known as lithotripsy, is a procedure which uses a focused sound wave to break cholesterol gallstones into small pieces. The pieces are then carried naturally out of the gallbladder and into the digestive system.
What kind of procedure should I have?
Your doctor will determine what kind of procedure is right for you. Laparoscopic (LC) surgery is growing in popularity because of its benefits when compared to traditional open procedures. Both types of surgery are safe and effective ways to remove the gallbladder.
After LC surgery, you can usually resume your normal activities after one or two weeks, depending on how quickly you recover. Some other benefits include:
- Shorter recovery time
- Shorter hospital stay (usually less than 24 hours)
- Less postoperative pain
- Less scarring
- Fewer complications
Open cholecystectomy is a more invasive procedure than LC, and requires more recovery time and a longer hospital stay.
Gallbladder Removal Surgery Recovery Tips
It’s normal for you to feel sick, bloated, or tired immediately after your surgery. Caring for your wounds and taking care of your health will speed along your recovery.
- Dress your stitches properly, cleaning the area, replacing dressings regularly, and applying any medication your doctor prescribes.
- Get plenty of sleep!
- Eat small, light meals immediately after the surgery, and build up to normal intake over the next few days.
- Exercise – but choose gentle activities such as walking.
- Do not drink alcohol for at least 24 hours after surgery.
If you experience fever, jaundice, pain, persistent nausea, or a return of your original symptoms, contact your doctor immediately as these could be signs of complications.
How do you live without a gallbladder?
It is absolutely possible to live a long and healthy life without a gallbladder.
Living without a gallbladder is rarely different than your normal lifestyle. After recovery, you can still be as active as you were prior to your surgery.
Most of your lifestyle changes will be diet-related. Since the gallbladder stores bile and helps digest fats, you may need to cut down on fatty food. You may also need to choose low-fat dairy, high fiber options, and limit foods which trigger side effects. Eating smaller meals throughout the day can also be beneficial to limiting or avoiding side effects
You generally want to aim for a balanced, healthy diet following any type of gallbladder removal surgery.Gallbladder removal usually occurs when a patient has gallstones that cause pain, jaundice, and nausea among other symptoms.
The gallbladder is not an essential organ, and people who have their gallbladders removed can live happy, normal lives. Lifestyle changes after gallbladder removal are mostly diet-centric and should not affect any exercise routines you may have.
Lifestyle Changes After Gallbladder Removal
After recovering from surgery, you can return to your normal activities without needing to alter or reduce the intensity of your work, workouts, or hobbies.
The main lifestyle changes you’ll expect following gallbladder removal surgery center around your diet. Your gallbladder was in charge delivering bile to your small intestine during mealtimes and storing bile when not needed, such as overnight.
Without a gallbladder, bile is constantly delivered to your small intestine. This means that you may experience some changes in your digestion. For most people, these side effects go away over time.
You may experience:
Your body will also digest food differently now that the flow of bile has changed. Fatty foods, full fat milk and dairy, and spicy foods may cause indigestion in some people. A balanced diet which is high and fiber and low in fat is a good place to start as you determine the right diet for you.
Dietary recommendations to help manage your digestion:
- Avoid fatty or fried foods
- Reduce or cut out spicy foods
- Choose high fiber foods and whole grains
- Choose plenty of vegetables
- Opt for low fat or non-fat dairy
- Reduce your caffeine intake if it causes indigestion
- Avoid eating a large meal after fasting
- Eat smaller meals throughout the day
You can live a healthy lifestyle without your gallbladder. Finding the right diet for your digestive system may take some time. Stay positive, experiment with different combinations of food and drink, and always consult your doctor with any questions or concerns you may have.
If you experience persistent symptoms, develop jaundice, become weak, or notice significant weight loss after surgery, you will want to speak to your doctor.
Can gallstones lead to gallbladder cancer?
The gallbladder produces a substance called bile which helps our small intestine break down fats in the foods we eat. Sometimes, gallstones develop in the gallbladder and prevent the normal flow of bile. Gallstones can cause blockages in the gallbladder, causing pain, discomfort, and complications such as cholecystitis. But can gallstones lead to gallbladder cancer?
According to the American Cancer Society, gallbladder cancer is estimated to affect approximately 11,000 people in the United States this year. Gallbladder cancer is a rare condition which can either start in the gallbladder or start in another area of the body and spread to the organ.
It is uncommon for people who develop gallbladder cancer to have gallstones. Gallbladder cancer occurs when malignant cells develop in the tissue or membrane of the gallbladder, while gallstones affect the normal flow of bile into and out of the gallbladder.
Gallbladder cancer can be hard to detect, as there are generally no signs or symptoms in the early stages. Symptoms can also mimic other diseases, leading to a delayed diagnosis. The gallbladder is located behind the liver, which can further make detection difficult.
When gallbladder cancer is detected, it is often in a later stage of progression. The early stages are limited to the gallbladder itself, and are easier to treat. Later stages can spread to surrounding muscles, organs, and tissue, and are more difficult to treat.
Gallstones vs. Gallbladder Cancer Symptoms
The symptoms of gallstones and gallbladder symptoms are similar in some respects, but should not be confused for one another.
Gallbladder cancer can be hard to detect, and is often caught in later stages or while seeking treatment for another health issue.
Symptoms of gallbladder cancer include:
- Nausea and vomiting
- Lumps in the abdomen
- Pain above the stomach
Some people may have gallstones and not even know it! Asymptomatic gallstones are often called ‘silent’ gallstones.
For other people, symptoms of gallstones – also known as ‘gallbladder attacks’ – occur during or after mealtimes. The gallbladder tries to release bile into the digestive tract to help break down fats, but the bile is blocked by a gallstone. Gallbladder attacks may last for one or several hours, and stop when the gallstone moves.
Symptoms of gallstones include:
- Pain in the right shoulder
- Pain in the central abdomen or upper right portion of the abdomen lasting at least 30 minutes
- Pain between the shoulder blades
- Clay-colored stools
Speak to your healthcare provider if you experience the symptoms of gallstones or gallbladder cancer. The sooner you seek treatment, the more likely you are to catch a problem before it gets worse!
Treatment for Gallbladder Cancer
The type of treatment for gallbladder cancer will depend on the patient’s age and health, symptoms, and progression of the cancer.
The most common types of treatment are:
- Surgery. The gallbladder, tumor, and surrounding tissue may be removed to stop the spread of cancerous cells.
- Chemotherapy. Medication is administered by IV or capsule in a set regimen to destroy the cancerous cells, stop their growth and division, and prevent further spread.
- Radiation therapy. X-rays are used over a series of sessions to destroy cancerous cells. This method is often used to shrink tumors prior to surgery, or afterwards to get rid of any remaining cancerous cells.
What are gallbladder polyps?
Polyps are growths or lesions which protrude from the wall of an organ. They can occur in many areas within the body, including the gallbladder. When a person has gallbladder polyps, the polyp grows from the gallbladder wall into the interior of the gallbladder.
Most of the time, polyps are benign, meaning they are non-cancerous. Malignant polyps are cancerous and require treatment so they do not spread to other organs.
The type of treatment for malignant gallbladder polyps will depend on the size and location of the polyp. Your doctor will be able to make the best assessment of your specific case.
How a Gastroenterologist Can Help
A gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver. Gastroenterologist can help you understand your risks of gallstones, test you for other gallbladder health concerns, and help you find a plan to prevent future attacks.
Meet the Gastroenterology Department at Florida Medical Clinic
At Florida Medical Clinic, our gastroenterology department has helped countless patients with diseases or disorders of the gallbladder, pancreas, liver, esophagus, stomach, intestines, and colon. Our team is here to help patients during every step of their health journey and coordinate care with other providers—with the aim of helping patients achieve whole-body health.
To meet with a member of the Florida Medical Clinic gastroenterologist, click here to request an appointment. We’ll contact you within one business day to schedule your appointment.