What's the Matter with My Gallbladder? Dr. Bock Weighs In

Medically reviewed by Jiselle Bock, MD, MPH

Over 1.2 million gallbladder removals are performed annually in the United States, making it one of the most common surgical procedures.

If you're having concerning symptoms, potentially associated with your gallbladder, you're far from alone. Let's talk about what might be the matter with your gallbladder. 

First, the gallbladder is a small, pear-shaped organ tucked just under your liver. Its main job is to store bile, a digestive fluid produced by the liver and release it into your small intestine to help break down fats. When things aren't working quite right with your gallbladder, it can lead to a range of uncomfortable symptoms. These issues often stem from problems, such as gallstones. It's important to remember that only a health care professional, such as your primary care physician, can diagnose what's specifically causing your symptoms, so if you're experiencing concerning pain or discomfort, seeking medical advice is always the best first step.

With this in mind, we sat down with WakeMed general surgeon, Jiselle Bock, MD, MPH, to get answers to some of your most pressing questions about gallbladder health.

What are the typical signs of a gallbladder problem?

The gallbladder is a little bag that hangs off the main bile duct underneath the liver. Because of the deep location, the symptoms can be vague. A lot of patients will describe having had heartburn for several months prior to understanding the issue is with the gallbladder. 

Other symptoms include the following:

• Chest pressure and pain — Occasionally, patients present to the emergency department thinking they're having a heart attack, so gallbladder pain can be sub sternal.
• Vague discomfort in the abdomen
• Back pain 
• Fatty food intolerance that comes on a couple hours after a rich meal
• Muscle pain
• Pain in the upper right abdomen, sometimes radiating to the back or shoulder
• Nausea
• Vomiting
• Indigestion

Do all gallbladder issues involve gallstones?

There are several gallbladder issues a patient can experience, some not involving gallstones.

Gallstones can cause cholecystitis — a condition in which the flow of bile from the liver stops or slows due to inflammation within the gallbladder.

A calculus in the gallbladder refers to a gallstone, which is a hardened deposit of cholesterol, bile pigments and/or calcium salts that form inside the gallbladder. 

The gallbladder can also be injured by severe direct impact, illness, major burns and the individual being put on a ventilator. 

Biliary dyskinesia is another condition that happens when the gallbladder may not have stones, but may not be squeezing very well. When it squeezes poorly, patients can experience pain. 

What tests are available to diagnosis gallbladder issues?

One available test is the HIDA scan, or hepatobiliary iminodiacetic acid scan. It is a nuclear medicine imaging test that evaluates the function of the liver, gallbladder and bile ducts. It can help diagnose conditions, including gallstones, blockages and infections. This involves injecting dye. It is radio labeled and excreted into the biliary system and can show how much the gallbladder is injecting when it does contract. It can help determine if a patient has an acute cholecystitis blockage.

Another diagnostic measure and our go-to when someone is not in active, emergent distress is the abdominal ultrasound. This test can show the architecture of the anatomy, which is important if considering if a patient passed a stone from the gallbladder down the main bile duct or when searching for a blockage. Abdominal ultrasound is a noninvasive imaging test that uses sound waves to create pictures of the organs and blood vessels in your abdomen. It's also known as a transabdominal ultrasound. Sometimes radiologists will only see sludge when reviewing the images, and they will not see stones, but that doesn't mean the gallbladder is working normally. Sludge can be a problem because it can drip into the pancreas, leading to irritation.

If a patient presents to the emergency department in severe pain, the patient is likely to undergo a computed tomography (CT) scan. This test involves more radiation. Yet, it can can view multiple areas of the abdomen at the same time.

Magnetic resonance imaging (MRI) is another test. It lights up the bile ducts and the pancreatic ducts. It's helpful in telling us whether there are stones in the main bile ducts.

Sometimes patients have elevated liver levels, which we discover through obtaining labs. They may be high enough that it makes us consider if there is a stone, a blockage or something wrong with the pancreas. Those patients may need endoscopic evaluation with an endoscopic retrograde cholangiopancreatography (ERCP) prior to proceeding with gallbladder removal. ERCP involves gastroenterologists going down with a camera through the stomach into the small intestine, where the main bile duct dumps out into the duodenum. They go up the main bile ducts from the bottom and scoop stones out or take biopsies before surgery. This helps to clean out the "pipes."

What treatment is available for gallbladder issues and gallstones?

The standard treatment for gallbladder issues and gallstones is gallbladder removal, also known as cholecystectomy. This is a very safe surgery that quickly relieves problems for patients.

However, if we find a patient has gallstones as a result of performing diagnostic testing for another condition, but the patient is experiencing no symptoms, we will leave the gallbladder intact. People can lead a healthy life and never address gallstones if they are asymptomatic.

What are the risk factors for gallbladder issues and gallstones?

Genetics play a key role. Other risk factors are as follows:

• Obesity
• Female
• Being in 40s age range
• Sickle cell
• Pregnancy and childbirth
• Hemolytic blood diseases

Are there measures people can take to prevent gallbladder issues and gallstones?

I love to joke that I've never removed a gallbladder from a vegan. Lifestyle and genetic risk factors do abound. Gallbladder issues often run in families, and we have not otherwise found a correlation between gallbladder health issues and other lifestyle choices.

If someone is symptomatic with gallbladder issues or gallstones, I urge those patients to steer clear of fatty diets until after the gallbladder is removed. Once the gallbladder is removed, patients should slowly reintroduce high-fat food. 

I also encourage patients to eat probiotic foods along with two servings of fermented foods each day as well prior to surgery. The standard American diet does not include a lot of good bacteria. Our foods are largely preserved and refrigerated. This encourages our bodies to remain in a proinflammatory state. In fact, most chronic diseases are tied to inflammation. Healthier food options could include quinoa, kale (leafy greens) as well as a large variety of unprocessed whole fruits and vegetables. 

Research from the National Institutes of Health shows that beyond the impact on gut and gallbladder health, an unhealthy gut microbiome impacts mental and even bone health. 

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About Jiselle Bock, MD, MPH

Dr. Jiselle Bock is a board-certified, fellowship-trained general surgeon in WakeMed General Surgery with clinical interests in quality improvement in trauma and trauma systems development. She completed medical school at Tulane University School of Medicine in New Orleans, LA and her residency at Tulane University in New Orleans, LA. She went on to Louisiana State University School of Medicine in New Orleans, LA to complete a fellowship program.

Dr. Bock considers her patients like family. She believes it is a privilege to care for patients and walk with them as they endure, what is often, one of the worst times of their lives. With each patient, she asks herself, “What if this were my mother, my sister, my grandfather or my child?” With that in mind, she strives to do everything she can to help them and their families get through their experience as safely and comfortably as possible. No surgery is without risks, and she aims to ensure that patients and their families understand their options, so together, they can maximize the most good and least harm to achieve the highest quality of life for as long as possible.

Outside of work, Dr. Bock enjoys hiking, spending time with family, cooking and playing with her dogs.