From the Guidelines
Gallbladder distension and mild gallbladder wall edema are most commonly caused by gallstones (cholelithiasis), biliary sludge, or acute cholecystitis, as these conditions can obstruct the cystic duct and lead to bile stasis, inflammation, and subsequent gallbladder distension. The management of these conditions should prioritize reducing morbidity, mortality, and improving quality of life.
Causes of Gallbladder Distension
- Gallstones can obstruct the cystic duct, preventing bile from flowing out of the gallbladder, which leads to distension and inflammation 1.
- Biliary tract infections, such as acute cholangitis, can also cause gallbladder distension and edema, as bacteria can ascend from the intestine or reach the biliary system through the portal venous system 1.
- Other causes include pancreatitis affecting the nearby pancreas, hepatitis, hypoalbuminemia (low blood protein levels), heart failure, and rarely, gallbladder tumors.
- Certain medications like opioids can also cause gallbladder dysfunction by affecting the sphincter of Oddi.
- Prolonged fasting or receiving total parenteral nutrition can lead to bile stasis and subsequent gallbladder issues.
- Pregnancy-related hormonal changes may also contribute to gallbladder distension.
Treatment and Management
- Treatment depends on the underlying cause but often includes pain management with NSAIDs like ibuprofen (400-600mg every 6 hours) or acetaminophen (1000mg every 6 hours) 1.
- Antibiotics may be necessary if infection is present, such as piperacillin-tazobactam 3.375g IV every 6 hours or ceftriaxone 1-2g daily plus metronidazole 500mg every 8 hours.
- Endoscopic retrograde cholangiopancreatography (ERCP) plays a central role in the management of biliary obstruction in patients with acute cholangitis, and is the treatment of choice for biliary decompression in patients with moderate/severe acute cholangitis 1.
- Patients should maintain adequate hydration and initially follow a low-fat diet to reduce gallbladder stimulation while the condition resolves.
- Cholecystectomy (surgical removal of the gallbladder) may be necessary for severe or recurrent cases.
From the Research
Causes of Gallbladder Distension and Mild Gallbladder Wall Edema
- Gallbladder distension and mild gallbladder wall edema can be caused by various conditions, including:
- Acute cholecystitis, which is an inflammation of the gallbladder that can cause right upper quadrant pain, fever, and leukocytosis 2
- Choledocholithiasis, which is the presence of gallstones in the common bile duct and can cause serious complications such as cholangitis and gallstone pancreatitis 2, 3
- Biliary dyskinesia, which is a motility disorder of the gallbladder that can cause biliary colic in the absence of gallstones 2
- Gallstone disease, which can cause sudden onset right upper quadrant or epigastric abdominal pain and can lead to complications such as cholecystitis, choledocholithiasis, and ascending cholangitis 3
- Other possible causes of gallbladder distension and mild gallbladder wall edema include:
- Acute acalculous cholecystitis, which is an inflammation of the gallbladder without the presence of gallstones 4
- Functional gallbladder disorder, which is a condition where the gallbladder does not function properly 4
- Gallbladder polyps, which are growths on the gallbladder wall that can cause symptoms such as abdominal pain 4
- Gallbladder hydrops, which is a condition where the gallbladder becomes distended with fluid 4
- Porcelain gallbladder, which is a condition where the gallbladder wall becomes calcified 4
- Gallbladder cancer, which is a rare but serious condition that can cause symptoms such as abdominal pain and weight loss 4