Symptoms of Bad Gallbladder
The most common symptoms of a bad gallbladder include episodic upper abdominal pain (particularly in the right upper quadrant or epigastrium), fever, nausea, vomiting, abdominal distention, and jaundice. 1, 2, 3
Common Symptoms
Primary Symptoms
Biliary Colic/Pain:
- Severe pain in the epigastrium and/or right upper quadrant
- Steady intensity, often radiating to the upper back
- Relatively abrupt onset, frequently awakening patients from sleep
- Episodes lasting hours to up to a day 3
- Often triggered after meals, particularly fatty foods
Associated Symptoms:
- Nausea and vomiting
- Fever (particularly with acute cholecystitis or cholangitis)
- Jaundice (yellowing of skin/eyes when bile ducts are obstructed)
- Abdominal distention 2
Secondary/Dyspeptic Symptoms
- Indigestion, belching, bloating
- Abdominal discomfort
- Heartburn
- Food intolerance (especially to fatty foods)
Note: These dyspeptic symptoms are common in persons with gallstones but may be unrelated to the stones themselves and frequently persist after surgery 3
Clinical Scenarios of Gallbladder Disease
1. Biliary Colic/Symptomatic Gallstones
- Intermittent right upper quadrant or epigastric pain
- Pain typically lasts 1-6 hours
- Often precipitated by fatty meals
- No fever or leukocytosis between episodes
2. Acute Cholecystitis
- Persistent right upper quadrant pain (>6 hours)
- Fever, nausea, vomiting
- Positive Murphy's sign (pain with inspiration when pressing on gallbladder)
- Affects approximately 200,000 people in the US annually 4
- 90-95% associated with gallstones (calculous cholecystitis)
- 5-10% without gallstones (acalculous cholecystitis) 4
3. Bile Duct Obstruction/Injury
Two most frequent clinical scenarios 2:
Bile leakage:
- Early visible sign is bile from drain or surgical incision
- Perihepatic bile collection (biloma), abscess, or biliary peritonitis may develop
- Jaundice typically not observed or mild
Bile duct obstruction:
- Cholestatic jaundice with choluria (dark urine)
- Fecal acholia (pale stools)
- Pruritus (itching)
- Fever with chills if cholangitis develops
Diagnostic Evaluation
Laboratory Tests
- Liver function tests:
- In critically ill patients:
- CRP, PCT, and lactate levels help evaluate severity of inflammation/sepsis 2
- Complete blood count 1
Imaging
- Abdominal ultrasound:
- First-line investigation for gallstone disease
- Sensitivity ~81%, specificity ~83% for acute cholecystitis 4
- HIDA scan:
- Gold standard for diagnosing acute cholecystitis
- 80-90% sensitivity
- Absence of gallbladder filling within 60 minutes indicates cystic duct obstruction 1
- Abdominal triphasic CT:
- First-line diagnostic imaging to detect intra-abdominal fluid collections and ductal dilation 2
- CE-MRCP (Contrast-Enhanced Magnetic Resonance Cholangiopancreatography):
- For exact visualization, localization, and classification of bile duct injuries
- Essential for planning tailored treatment 2
Treatment Options
Symptomatic Management
- NSAIDs may be the treatment of choice for patients with gallstones suffering acute pain attacks 3
- Broad-spectrum antibiotics for suspected infection 1
Definitive Treatment
Laparoscopic cholecystectomy:
Percutaneous cholecystostomy tube:
ERCP with biliary sphincterotomy:
- For common bile duct stones
- May be considered to reduce risk of recurrent biliary events if cholecystectomy is contraindicated 1
Post-Treatment Considerations
- Dietary modifications may help manage symptoms after cholecystectomy, particularly limiting processed meat and fried fatty foods 5
- Some individuals may experience mild discomfort or alterations in bowel patterns, especially after consuming high-fat meals 5
- Persistent dyspeptic symptoms occur frequently following cholecystectomy, particularly in those with prolonged history of such symptoms prior to surgery 3
Warning Signs Requiring Immediate Attention
- Fever with chills (suggesting cholangitis)
- Severe, unrelenting abdominal pain
- Jaundice developing rapidly
- Signs of sepsis or multiorgan failure 2