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Gallbladder disease

There are several types of gallbladder disease:

Cholecystitis is the most common type of gallbladder disease, and often what medical professionals associate with the phrase. Inflammation of the gallbladder. It is caused by gallstones obstructing the ducts to the small intestine. In addition to upper right abdominal pain, cholecystitis carries with it a variety of symptoms, “including fever, positive Murphy’s sign [pain when the abdominal area is examined], nausea and vomiting. Treatment depends on the severity of the symptoms. This can often be managed by rest and antibiotics, but for severe cases, surgery is the definitive treatment.

After several attacks of pain, chronic cholecystitis may occur. This involves the gallbladder shrinking and losing its function.

Those prone to gallbladder disease usually fall into the “5 F's”: fair, fat, 40, female, and flatulent! 

Choledocholithiasis is the “presence of at least one gallstone in the common bile duct". It can block the flow of bile and cause the gallbladder to become inflamed or distended. 

Acalculous gallbladder disease occurs without the presence of gallstones. It happens when the gallbladder muscles or valve are not working correctly, and is often found in patients who are suffering from other serious disorders.

Cholangitis is inflammation in the common bile duct. The most common cause is gallstones becoming lodged in the bile duct, though the condition can also be caused by bacterial infections, blockages caused by medical procedures, and tumors. 

Gallbladder cancer is relatively rare. It can be difficult to diagnose because its symptoms are similar to other gallbladder ailments (nausea, vomiting, jaundice, fever).

Gallbladder polyps are lesions or growths in the gallbladder that are usually harmless and carry no symptoms. They can occasionally be a risk factor for gallbladder cancer.

Gangrene results from inadequate blood flow and can develop in the gallbladder if acute cholecystitis is left untreated. The symptoms are: confusion, fever, gas in tissues under the skin, feeling ill, low blood pressure and persistent pain. 

Abscesses occur when the gallbladder becomes inflamed with pus. Like gangrene, it can occur as a complication of acute cholecystitis.

Gallstones (gallbladder stones)

Gallstones are solidified particles of substances in the bile. They are made of a “combination of bile salts, cholesterol and bilirubin,” said Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital. Gallstones can be as small as a grain of sand or as large as a golf ball, according to The Oregon Clinic. 

Gallstones can be painful, and cause obstruction,” Knowlton said. “Depending on where the obstruction is, [it] causes a variety of problems: gallbladder obstruction (cholecystitis), biliary tree obstruction (jaundice) and pancreatic duct obstruction (pancreatitis).” Gallstones can block the gallbladder ducts so that bile cannot reach the small intestine as effectively, which may prevent the gallbladder from doing its job and can lead to other gallbladder diseases.

Gallstones can range in size from a grain of sand to a golf ball.

Knowlton explained that while most gallstones pass on their own, some require a minor procedure or even surgery. “Diagnosis can be made by labs, ultrasound, or Hida scan,” she said. 

According to the Mayo Clinic, factors that contribute to the risk of gallstones include obesity, high-fat or high-cholesterol diets, diabetes and taking medicines with estrogen. Women, people over 60, Native Americans and Mexican-Americans are also at a higher level of risk.

Gallbladder polyps

Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) in the wall of the gallbladder. True polyps are abnormal accumulations of mucous membrane tissue that would normally be shed by the body. The main types of polypoid growths of the gallbladder include cholesterol polyp/cholesterosis, cholesterosis with fibrous dysplasia of gallbladder, adenomyomatosis, hyperplastic cholecystosis, and adenocarcinoma.


Polypoid lesions of the gallbladder affect approximately 5% of the adult population. The causes are uncertain, but there is a definite correlation with increasing age and the presence of gallstones (cholelithiasis). Most affected individuals do not have symptoms. The gallbladder polyps are detected during abdominal ultrasonography performed for other reasons.

The incidence of gallbladder polyps is higher among men than women. The overall prevalence among men of Chinese ancestry is 9.5%, higher than other ethnic types.


Most small polyps (less than 1 cm) are not cancerous and may remain unchanged for years. However, when small polyps occur with other conditions, such asprimary sclerosing cholangitis, they are less likely to be benign. Larger polyps are more likely to develop into adenocarcinomas.

Cholesterolosis is characterized by an outgrowth of the mucosal lining of the gallbladder into fingerlike projections due to the excessive accumulation of cholesterol and triglycerides within macrophages in the epithelial lining. These cholesterol polyps account for most benign gallbladder polyps.

Adenomyomatosis describes a diseased state of the gallbladder in which the gallbladder wall is excessively thick, due to proliferation of subsurface cellular layer. It is characterized by deep folds into the muscularis propria. Ultrasonography may reveal the thickened gallbladder wall with intramural diverticulae, called Rokitansky-Aschoff sinuses.

Symptoms and diagnosis

Most polyps do not cause noticeable symptoms. Gallbladder polyps are usually found incidentally when examining the abdomen by ultrasound for other conditions, usually abdominal pain.


Most polyps are benign and do not need to be removed. Polyps larger than 1 cm or polyps with gallstones should be properly examined and better removed by gallbladder preserving cholelithotomy surgery at our hospital. We check a gallbladder polyp twice (during and after surgery) to make sure it's not malignant.


What is the gallbladder

Gallbladder is a 4-inch, pear-shaped organ. It’s positioned under your liver in the upper right section of your abdomen. The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in your intestine. The gallbladder delivers bile into the small intestine. This allows fat-soluble vitamins and nutrients to be more easily absorbed into the bloodstream.

 Gallbladder function

The main purpose of the gallbladder is to store bile, also called gall, needed for the digestion of food. The gallbladder is part of the biliary system and serves as a reservoir for bile, which is produced by the liver. The liver produces the bile and then it flows through the hepatic ducts into the gallbladder. At any one time, 30 to 60 millilitres (1.0 to 2.0 US fl oz) of bile is stored within the gallbladder.

When food containing fat enters the digestive tract, it stimulates the secretion of cholecystokinin (CCK) from I cells of the duodenum and jejunum. In response to cholecystokinin, the gallbladder rhythmically contracts and releases its contents into the common bile duct, eventually draining into the duodenum. The bile emulsifies fats in partly digested food, thereby assisting their absorption. Bile consists primarily of water and bile salts, and also acts as a means of eliminating bilirubin, a product of hemoglobin metabolism, from the body.

The bile that is secreted by the liver and stored in the gallbladder is not the same as the bile that is secreted by the gallbladder. During gallbladder storage of bile, it is concentrated by removal of some water and electrolytes. This is through the active transport of sodium ions across the epithelia of the gallbladder, which creates an osmotic pressure that also causes water and other electrolytes such as chloride to be reabsorbed.

Gallbladder inflammation

Inflammation of the gallbladder is known as cholecystitis. Inflammation is most commonly because of obstruction of the duct with gallstones, known as cholelithiasis. Blocked bile accumulates, and pressure on the gallbladder wall may lead to the release of substances that cause inflammation, such as phospholipase. There is also the risk of bacterial infection. An inflamed gallbladder is likely to cause pain and fever, and tenderness in the upper, right corner of the abdomen, and may have a positive Murphy's sign. Cholecystitis is often managed with rest and antibiotics, particularly cephalosporins and, in severe cases, metronidazole.

Cholecystitis may also occur chronically, particularly when a person is prone to getting gallstones.

No more gallbladder removal

Published on 19.01.2012

Gallbladder removal doesn't need anymore

Surgery to remove the gallbladder, known as a cholecystectomy, is one of the most common surgeries done in the United States, performed on more than half a million people each year. The surgery is chosen when other methods, such as medications or ultrasound to break up the stones (lithotripsy) have not been successful in relieving symptoms or eliminating the stones.

Conventional cholecystecomy involves removing the gallbladder by one of two methods: laparoscopically through four small incisions in the abdomen with the assistance of a tiny video camera; or through one large incision in the abdomen. Both methods are associated with side effects and complications, although the laparoscopic technique, which is more common, is less risky.

A team of scientists in China, however, have developed a device that allows removal of gallstones without taking out the gallbladder. The patented, specially designed endoscope allows clinicians to locate and remove gallstones and other gallbladder lesions by sucking them out of the body like a vacuum.


The systematic classification of gallbladder stones

Published on 4.10.2013

The Systematic Classification of Gallbladder Stones

Tie Qiao, Rui-hong Ma, Xiao-bing Luo, Liu-king Yang, Zhen-liang Luo and Pei-ming Zheng


Cholecystolithiasis is a common disease worldwide. The incidence of gallstones is 15% in America, 5.9∼21.9% in Europe, 4∼15% in Asia and 3∼11% in China. Current research suggests that different types of gallstones have different pathogenesis. Research on the systematic classification of gallbladder stones may help to reveal the formation mechanism of different types of gallstones. The traditional classification scheme classified gallstones into 3 types according to cholesterol content, including cholesterol stone (cholesterol content ≥70%), pigment stone (cholesterol content ≤30%) and mixed stone (30% ≤cholesterol content ≤70%. Professor Fu et al (1984) divided gallstones into 8 types according to the profile structure and chemical components. These included radial, radial annual ring-like, rock strata-like stromatolite, cast amorphous, sand bed-like stromatolite, silt-like, black, and complex stones. Among these, the radial, radial annual ring-like, and rock strata-like stromatolite stones were cholesterol stones, and the cast amorphous, sand bed-like stromatolite, and silt-like stones were pigment stones. With the application of infrared spectroscopy in recent years gallstones have been classified into cholesterol stones, pigment stones, mixed stones and other rare stones (including calcium carbonate, calcium phosphate, and fatty acid calcium stones). The traditional classification, using one or two means (chemical components, the profile structure and chemical components or infrared spectroscopy), is rough and not very accurate, therefore, we question the traditional classification for gallbladder stones and raise the possibility of developing a systematic classification scheme. Using FTIR Spectroscopy, Scanning Electron Microscopy and X-ray energy spectrometer and classifying gallstones according to the appearance, profile structure, component content and distribution, microstructure, elemental composition and distribution, the new systematic classification scheme, makes up the deficiency of the traditional classification, and thus is more accurate. 


Tiny cystine stones in the gallbladder

Published on 29.03.2012

Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis

complicating acute cholecystitis: a case report

  • Tie Qiao
  • Rui-hong Ma
  • Xiao-bing Luo
  • Yu-yang Feng
  • Xing-qiang Wang
  • Pei-ming Zheng
  • Zhen-liang Luo


Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder. In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.


Cystine stones Urinary calculi Gallstones


CS - Cystine stones

UC - Urinary calculi

GS - Gallstones

CS - Cholesterol stones

BPG - Bile pigment stones

MS - Mixed stones

CCS - Calcium carbonate stones

CPS - Calcium phosphate stones

FAS - Fatty acid stones

FTIR - Fourier transform infrared spectroscopy

SEM - Scanning electron microscope

XRES - X-ray energy spectrometer


Cholecystolithiasis, or gallbladder stone is a common and frequently encountered disease worldwide. Gallbladder stones can be divided into four groups according to their location: intracavitary, cystic duct, intramural, and mucosal stones (small stones adhering to the mucosa). Based on their main component, gallbladder stones are divided into cholesterol stones, bile pigment stones, mixed stones, and other types (including calcium carbonate stones, calcium phosphate stones, fatty acid stones, and cystine stones); this classification is mainly based on the infrared spectrum of the stones. Compared with other types of stones, cystine stones are rare in the gallbladder, although they are common in the urinary system. We report a patient with cystine gallstones.