Gallbladder Disease and Liver Health

By Stephen Holt, MD, PhD, FACP

• What is Gallbladder Disease?
• Causes
• Who is at Risk?
• Symptoms
• How is it Diagnosed?
• Treatment
• Can You Liver Without a Gallbladder?
• Alternative Treatments
  • What is a Gallbladder Cleanse and is it Safe?
• Suggested Articles

What is Gallbladder Disease?

The gallbladder is a pear-shaped organ which lies just beneath the liver on the right side of the abdomen. Measuring approximately 3 to 4 inches long and about 1 inch wide, its main function is to store and concentrate bile which is produced in the liver. Bile, a bitter, greenish mixture of acids, salts and other substances is carried by the bile ducts which connects the liver and the gallbladder. Bile aids in the digestion of fat, and is released from the gallbladder into the upper small intestine (duodenum) in response to food (especially fats).

Gallbladder disease, also called biliary disease, includes stones, infection, inflammation, or blockage (obstruction) of the gallbladder.

A person with liver disease who is experiencing abdominal pain and/or pain over the liver (right upper quadrant pain) should not automatically attribute the pain to a liver disorder – other causes should be investigated. In fact, abdominal and right upper quadrant pain is rarely due to chronic liver disease. Most commonly, right upper quadrant pain, when due to the liver, occurs in the acute stages of liver disease or during a flare-up of a chronic liver disease. The cause of the pain, in these instances, is acute inflammation, distention of the liver and irritation. Otherwise, the liver is rarely tender in people with chronic liver disease.

Causes

Types and causes of gallbladder disease include:

• Gallstones (cholelithiasis) – the most common type of gallbladder disease. Hardened deposits of digestive fluid that can form in the gallbladder which vary in size from a few millimeters to a few centimeters. Two types of gallstones are cholesterol gallstones and pigment gallstones.
• Cholecystitis (inflammation of the gallbladder) – caused by a gallstone getting stuck in the cystic duct, the tube that carries bile from the gallbladder. Infection, injury and tumors can also cause cholecystitis.
• Polyps (growths of tissue in the gallbladder).
• Chronic acalculous gallbladder disease – when the natural movements needed to empty the gallbladder do not work well.
• Gangrene (death of tissue) or abscesses (pockets of pus).
• Sclerosing cholangitis – swelling (inflammation), scarring, and destruction of the bile ducts inside and outside of the liver.
• Congenital defects of the gallbladder (defects that are present at birth).
• Tumors of the gallbladder and bile ducts.
• Gallbladder cancer – a rare disease in which malignant (cancer) cells form in the tissues of the gallbladder.

Who is at Risk?

It is most commonly seen in women, although men can suffer as well. The most common reason for gallbladder disease is gallstones. Rarely found in young people, risk of developing gallstones increases as one ages.

Factors that may increase the risk of developing gallstones are:

• A family history of gallstones
• Being female
• Being 60 years old or older
• Diabetes
• High blood cholesterol level
• Being on cholesterol lowering medication
• A diet high in cholesterol
• A low fiber diet
• Rapid weight loss
• Taking drugs that contain estrogen (such as hormone replacement therapy and birth control pills)
• Being an American Indian
• Being a Mexican-American
• Excess weight or obesity
• Pregnancy
• Biliary strictures (biliary tract narrowing)

Gallstones often occur in people with liver disease – especially those with primary biliary cirrhosis (PBC) – or those with cirrhosis due to any liver disease.

Symptoms

Symptoms vary widely from discomfort to severe pain which mainly begins after food intake. Pain is generally located in the right upper or middle upper abdomen. In severe cases, the patient can suffer from jaundice, nausea and fever. The most common reason for gallbladder disease is gallstones, which is why it is usually referred to as gallstone disease. However, it is possible to have gallstones and never have any symptoms.

Other symptoms of gallbladder disease that may occur:

• Pain that spreads to the back or below the right shoulder blade
• Abdominal fullness
• Clay-colored stools
• Fatigue
• Enlarged liver
• Enlarged spleen
• Repeat episodes of cholangitis (an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines)
• Chills
• Dark urine

How is it Diagnosed?

A thorough physical examination which will spot a distended abdomen and jaundice, along with the following tests, may be performed in order to make a diagnosis.

• Complete blood count (CBC) – examines levels of different types of blood cells such as white blood cells. A high white blood cell count may indicate infection.
• Abdominal X-ray – which may show evidence of gallbladder disease, such as gallstones.
• Liver function tests (LFTs) – blood tests that can show evidence of gallbladder disease.
•  Blood test – A check of the blood’s amylase or lipase levels to look for inflammation of the pancreas. Amylase and lipase are enzymes produced in the pancreas.
• Ultrasound – uses sound waves to image the intra-abdominal organs including the gallbladder.
• Computed tomography (CT)- scan that constructs X-ray images of the abdominal organs.
• HIDA scan (cholescintigraphy) – a radioactive material called hydroxy iminodiacetic acid (HIDA) is injected into the patient. The radioactive material is taken up by the gallbladder to measure gallbladder function.
• Magnetic resonance cholangiopancreatography (MRCP) – uses magnetic resonance imaging (MRI) to produce detailed pictures.
• Endoscopic retrograde cholangiopancreatography (ERCP) – a tube is placed down the patient’s throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder, liver, and pancreas can be seen on X-ray.

Treatment

Gallstones that do not cause pain or other symptoms typically do not require treatment, however, when treatment is required, the following are common treatments for gallbladder disease:

• Antibiotics – to prevent infection from spreading which may occur when inflammation is present in the gallbladder (cholecystitis)
• Extracorporeal shock-wave lithotripsy – when only a few small gallstones are present, high-energy shockwaves are projected from a machine through the abdominal wall, breaking up gallstones.
• Chemotherapy and radiation therapy – may be used after surgery for gallbladder cancer to help prevent cancer from returning.
• Gallbladder surgery (cholecystectomy) – the gallbladder is removed, using either laparoscopy (several small cuts) or laparotomy (traditional “open” surgery with a larger incision).
• Ursodeoxycholic acid – an oral medication for individuals who are not good candidates for surgery due to problems with gallstones. Ursodeoxycholic acid may help dissolve small cholesterol gallstones and reduce symptoms. Another oral solution is called Chenix.
• Contact solvent dissolution – rarely used, a needle is inserted through the skin into the gallbladder, and chemicals are injected that dissolve gallstones

Can You Live Without a Gallbladder?

Interestingly, it is not necessary to have a gallbladder in order to survive. Once it is removed, bile flows directly from the liver into the small intestine, rather than being stored in the gallbladder. Gallbladder removal does not affect the ability to digest food, however, diarrhea can occur.

Alternative Treatments

Some people turn to alternative methods of treatment for gallstone cures such as a gallbladder cleanse. However, no alternative therapies have been proved to dissolve or cure gallstones. Consulting with one’s physician is advisable when considering methods to reduce the risk of complications due to gallstones. Recommendations may be made to eat a high fiber diet which includes healthy fats and taking vitamin supplements.

What is a Gallbladder Cleanse and is it Safe?

A gallbladder cleanse, also known as a gallbladder flush, a liver cleanse or a liver flush is an alternative remedy for potentially ridding the body of gallstones and other toxins. Gaining popularity as a way to quickly eliminate toxins from the liver and the gallbladder, one of the most popular recipes calls for drinking a combination of Epson salts, grapefruit juice, various herbs and olive oil.

It is said, following the cleanse, people see what looks like gallstones in their stools the next day, but what they are actually seeing is globs of oil, juice and other materials – not gallstones.

Gallbladder cleanses are not without risk, as abdominal pain, nausea, vomiting and diarrhea may occur during the cleansing period. Dangerous dehydration and electrolyte imbalance can be the result of the colonic effect of Epsom salts. Furthermore, Epsom salts in high dosages can lead to dangerous magnesium toxicity. If taking medications, Epsom salts may cause a dangerous interaction, so it’s best not to take any medications during the cleansing process.

Also at risk are individuals taking medications when grapefruit juice interacts with them, particularly channel blockers and cholesterol lowering drugs such as Zoloft, Zocor and Lipitor. Because a large amount of oil can cause the gallbladder to contract, causing the stones to get lodged in the narrower openings of the gallbladder, a gallbladder cleanse could be dangerous for individuals who require surgery to remove them.

Finally, pregnant women and people who are in poor health should not use a gallbladder cleanse.

The best means of supporting a healthy gallbladder is to eat healthy foods, exercise regularly, lose weight slowly and maintain a healthy weight.

This information is intended for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

Suggested Articles

• How You Can Stop HCV from Leading to Gallstones
• 18 Little Known Facts About Liver Disease

About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.