What are the symptoms of a contracted gallbladder?

Symptoms of a Contracted Gallbladder

A contracted gallbladder typically presents with right upper quadrant abdominal pain, which may be severe and episodic in nature, often accompanied by nausea, vomiting, and anorexia. 1

Clinical Presentation

• Right upper quadrant and/or epigastric pain is the most characteristic symptom, which can be severe and steady in intensity 1, 2
• Pain may radiate to the upper back or right infrascapular area 1, 2
• Episodes typically last from 30 minutes to several hours or even up to a day 1, 2
• Pain often builds to a steady level and may awaken patients from sleep 1, 2
• Nausea and vomiting occur in approximately 60% of cases 2, 3
• Anorexia (loss of appetite) is common during symptomatic episodes 1
• Fever may be present, particularly if inflammation is significant 1

Diagnostic Features

• The gallbladder may appear contracted or distended on imaging, depending on the underlying pathology 1
• Pericholecystic fluid is usually absent in chronic conditions but may be present in acute complications 1
• Sonographic Murphy sign (focal tenderness over the gallbladder during ultrasound examination) may be present but has relatively low specificity 1
• Ultrasound is the first-line imaging modality with 96% accuracy for detecting gallstones 1
• The diagnosis of chronic cholecystitis with a contracted gallbladder can be difficult on anatomic imaging alone 1

Associated Symptoms

• Dyspeptic symptoms including indigestion, belching, bloating, and food intolerance are common but may not be directly related to the gallbladder condition 2
• Jaundice may be present in approximately 35% of cases, particularly if there is biliary obstruction 3
• Symptoms may worsen after fatty meals due to increased gallbladder contraction 2

Complications and Progression

• If obstruction persists, inflammation can progress to more severe conditions like empyema (pus in the gallbladder) 4
• Complications of gallstone disease occur at a rate of less than 1% annually in asymptomatic patients but at 2% in symptomatic patients 2
• Severe complications may include gangrenous, hemorrhagic, or perforated gallbladder 1, 4
• Symptoms may be recurrent, with approximately 6-10% of symptomatic patients experiencing recurrent episodes annually 2

Special Considerations

• Symptoms may mimic other conditions such as peptic ulcer disease, pancreatitis, or sphincter of Oddi dysfunction 1, 5
• In rare cases of gallbladder agenesis (absence of gallbladder), patients may present with similar symptoms despite not having a gallbladder 3, 5
• Elderly patients or those with diabetes may present with atypical or muted symptoms 4, 6
• The risk of acute cholecystitis appears greater in patients with large solitary stones 2

Clinical Evaluation

• Ultrasound is the first-line imaging test for suspected gallbladder disease with right upper quadrant pain 1
• If ultrasound is inconclusive, hepatobiliary scintigraphy has higher sensitivity (97%) and specificity (90%) for detecting acute cholecystitis 1, 6
• CT or MRI may be used when other imaging is equivocal or to evaluate for complications 1