Symptoms and Diagnostic Path
PAINis the primary symptom of gallbladder dis-
ease, and is characteristically:
- steady, sometimes intense pain between the
right rib cage and shoulder blade felt in the
front, back, or both - brought on by eating fatty foods, often occur-
ring several hours after eating - common at night, waking one from sleep
- one to five hours in duration
- not relieved by changing positions or taking
over-the-counter pain medications
Other symptoms of gallbladder disease include
NAUSEA, VOMITING, gastrointestinal distress (gas,
bloating, DIARRHEA) not relieved by ANTACIDS, and
light-colored stools that contain noticeable mucus.
When a gallstone blocks a bile duct there often is
JAUNDICE(yellowish discoloration of the SKIN) and
severe tenderness over the site of the blockage.
FEVER, chills, and unrelenting pain may signal an
infection in the gallbladder. These circumstances
require immediate medical attention.
The doctor’s physical examination includes a
careful history of symptoms as well as palpation of
the abdomen. The diagnostic path typically
includes ULTRASOUNDof the upper right abdomen,
which can detect gallstones as small as 2 millime-
ters—about the size of a thick pencil lead. It also
can show thickening of the gallbladder’s wall, an
indication of chronic inflammation and previous
gallstone development. Because the liver shadows
the gallbladder, ultrasound does not always detect
inflammation related to acute cholecystitis or cer-
tain other gallbladder problems. Contrast dye X-
RAY(oral or intravenous) and radioisotope imaging
(cholescintigraphy) provide detailed information
about gallbladder function.
Treatment Options and OutlookMild and infrequent symptoms may require no
intervention beyond watchful waiting and lifestyle
modifications such as eating a diet lower in fat,
getting daily physical exercise, and WEIGHT LOSS
AND WEIGHT MANAGEMENT.ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY(ERCP) often is success-
ful in removing small gallstones from the bile ducts.
Surgery to remove the gallbladder (CHOLECYS-
TECTOMY) is the treatment of choice for acute,
recurrent, or chronic cholecystitis and cholelithia-
sis in which gallstones cause pain and bile duct
obstruction. There are two methods for perform-
ing cholecystectomy: laparoscopic surgery and
OPEN SURGERY. About 95 percent of cholecystec-
tomies performed in the United States are laparo-
scopic.
Medications to dissolve gallstones are not very
successful and can cause significant side effects.
Current treatment guidelines recommend these
medications only when surgery is not a viable
option. The two drugs doctors sometimes use are
ursodiol (Actigall) and chenodiol (Chenix).
Though EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY
(ESWL) is effective in breaking up KIDNEYstones, it
so far has not proven to be successful in doing the
same with gallstones.
About a third of people who have one gallblad-
der episode, such as a gallstone that causes pain,
never have another. The gallbladder is an organ
that, though useful, the body does not require.
Most people make a full recovery from gallbladder
surgery and can resume their normal activities
without modification. No dietary restrictions or
medications are necessary.Risk Factors and Preventive Measures
Women are twice as likely as men to develop gall-
bladder disease. Researchers believe this increased
risk correlates to the presence ofESTROGENS, which
play an integral role in cholesterol METABOLISM.
Women who are pregnant or taking oral contra-
ceptives (birth control pills), which increase the
body’s level of estrogen, are at highest risk. Gall-
bladder disease seldom occurs in children.
These factors increase the risk for gallbladder
disease in men and women alike:- OBESITY
- rapid weight loss or weight cycling
- DIABETES
- taking lipid-lowering medications
- age 60 or older
Lifestyle habits such as nutritious diet and reg-
ular physical exercise minimize the likelihood ofgallbladder disease 47