The complications of gallbladder disease are mainly due to the presence of gallstones and may include an infection of the common bile duct (called ascending cholangitis), inflammation of the pancreas (called pancreatitis), gangrene of the gallbladder (called gangrenous cholecystitis), or bowel obstruction from a gallstone (called gallstone ileus).
Frequent Symptoms
The common symptoms of gallbladder disease may help differentiate the usual causes.
Abdominal Pain
Most gallstones stay in the gallbladder and don’t cause symptoms. Some become lodged in the cystic duct (a tube located at the neck of the gallbladder) or in the common bile duct (a tube that carries bile from the gallbladder to the intestines).
A gallstone in the common bile duct is called choledocholithiasis and may cause intermittent or constant discomfort. A gallstone obstruction of the cystic duct is called biliary colic.
Besides a gallstone attack, upper right-sided abdominal pain may occur in other gallbladder diseases, such as:
Cholecystitis: This condition refers to gallbladder inflammation. While it most commonly occurs as a complication of gallstones (called acute cholecystitis), it may also occur without gallstones (called acalculous cholecystitis). Unlike a gallstone attack, the biliary-like pain of cholecystitis lasts longer than six hours and is usually associated with fever and an elevated white blood cell count. Biliary dyskinesia: This condition causes upper abdominal pain and occurs when the sphincter of Oddi (a muscular structure located at the junction where the bile ducts drain into the small intestine) does not function properly, causing bile blockage. Functional gallbladder disorder: This disorder causes episodes of upper abdominal pain without gallstones or problems with the sphincter of Oddi. Advanced gallbladder cancer: Gallbladder cancer generally does not cause symptoms. As the cancer grows, though, pain in the upper right side of the abdomen may begin, along with palpable lumps on the belly, jaundice, nausea, fatigue, and weight loss.
Jaundice
Jaundice, signaled by yellowing of the whites of the eyes and skin, may occur with gallbladder diseases that obstruct the bile ducts.
Nausea and Vomiting
Nausea and vomiting may occur with a gallstone attack but are more common with cholecystitis (inflammation of the gallbladder) or pancreatitis (inflammation of the pancreas).
Fever
Fever should not occur with a gallstone attack but may occur with gallbladder inflammation or with infection/inflammation of the biliary tract.
Rare Symptoms
There are also less common symptoms of gallbladder disease. Sometimes it isn’t clear whether the symptoms are caused by gallstones or by another coexisting medical condition, like gastroesophageal reflux disease (GERD) or peptic ulcer disease.
Pruritus
Pruritus (itching) is another symptom, occurring commonly with a condition called primary sclerosis cholangitis, a chronic, inflammatory disease of both the gallbladder and liver. The pruritus that occurs with these conditions is often very debilitating and likely occurs as a result of bile acid accumulation.
Chest painBurpingFeeling full sooner than usual after eatingRegurgitating fluidsBloatingBurning sensation behind the breastbone or in the upper central abdomenNausea and/or vomiting without biliary colic
Primary sclerosing cholangitis can also cause upper right-sided abdominal pain, jaundice, and fatigue.
Pruritus can also occur with advanced forms of pancreatic cancer due to blockage of the bile duct.
Complications
Several complications may occur as a result of gallbladder disease.
Acute Cholangitis
Acute cholangitis is caused by a bacterial infection of the biliary tract associated with biliary obstruction. In addition to fever and upper right-sided abdominal pain, the condition can cause jaundice, low blood pressure, and confusion.
Pancreatitis
Pancreatitis refers to inflammation of the pancreas and most commonly occurs as a complication of gallstones. This is because the gallbladder and pancreas share a bile drainage duct, so an obstructing gallstone can prevent the flow of pancreatic enzymes.
Gangrenous Cholecystitis
This is the most common complication of cholecystitis, especially for older people, people with diabetes, or anyone who delays seeking treatment for their gallbladder attacks. Gangrenous cholecystitis is considered a medical emergency, requiring surgical removal of the gallbladder (a cholecystectomy) right away.
Gallbladder Perforation
If the gallbladder becomes gangrenous, a perforation (a hole in the wall of the gallbladder) may develop, resulting in a pericholecystic abscess (a collection of pus within the gallbladder). This complication is serious and life-threatening, requiring an emergent cholecystectomy.
Cholecystoenteric Fistula/Gallstone Ileus
If a hole forms in the gallbladder, a fistula (passage) into the small intestine may develop. If a gallstone passes through the fistula, a bowel obstruction may occur (called gallstone ileus).
Emphysematous Cholecystitis
Infection of the wall of the gallbladder with gas-forming bacteria may lead to emphysematous cholecystitis. Older age and diabetes increase the risk of this complication.
When to See a Healthcare Provider
If you are experiencing any abdominal pain, it’s important to see your healthcare provider for a proper diagnosis. If your healthcare provider diagnoses you with gallstones, they may refer you for a surgical evaluation, especially if you are experiencing recurrent episodes of biliary colic.
If you are experiencing abdominal pain that is severe, persistent, and/or associated with fever, severe nausea, vomiting, and/or jaundice, be sure to seek medical attention right away at the hospital.
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FeverJaundiceNausea and vomitingPruritis (itching)
Be sure to contact your healthcare provider if you have any type of severe abdominal pain, and especially if you have signs of jaundice, such as yellowing of the eyes, as serious complications may arise.
Gastroesophageal reflux disease (GERD)AppendicitisGastroenteritis (stomach flu)Irritable bowel syndrome (IBS)Gallbladder cancerPancreatitisKidney stonesGastritisPeptic ulcer disease
