What causes gallbladder symptoms?


To understand how gallbladder symptoms develop, it’s helpful to understand the role of the gallbladder in digestion of the fatty food.

Bile is normally made in the liver and is stored in the gallbladder. When a person eats, the body senses that fatty food has entered the first part of the intestine and sends out a signal (“CCK” or cholecystokinin) that tells the gallbladder to squeeze and send the bile down through ducts to the intestine. Once in the intestine, the bile mixes with the fats and breaks them down to tiny particles that can be absorbed. 

When there is a problem with getting bile into the intestine after a fatty meal, patients can experience gallbladder symptoms such as bloating, belching, fullness, nausea, and vomiting related to having undigested fats in the intestine. These fats are broken down by bacteria in the gut and foul smelling gas is created. Undigested fats may also cause disruptions in normal bowel movements which can result in loose bowel movements after fatty meals.

The most common cause of gallbladder symptoms involves the development of gallstones. Gallstones develop when the bile becomes over concentrated and the water is absorbed leaving behind a solid stone. These stones can block the ducts of the gallbladder and prevent the bile from exiting when the body signals the gallbladder to squeeze. This often results in sudden onset of pain in the right upper abdomen or mid upper abdomen that can travel into the back in addition to the symptoms described above. This pain can last minutes to days, can be sharp or dull, and can worsen or improve over time depending on different factors. Sometimes the pain stops just as abruptly as it started. This can mean that the stone has bounced back into the gallbladder and is no longer blocking the duct or it can pass through the ducts. 

Many patients present with gallbladder symptoms but no stones are seen on imaging tests. Though gallbladder symptoms related to gallstones are far more common, the gallbladder can also malfunction without stones. Gallbladder dysfunction that leads to gallbladder symptoms without the presence of gallstones is called biliary dyskinesia. Sometimes the gallbladder doesn’t respond correctly to the signal to squeeze. It can respond by ineffectively squeezing or by squeezing too aggressively. 

Biliary dyskinesia can cause the same pain as is experienced by people who have gallstones and result in improper digestion of fats which can lead to bloating, belching, fullness, nausea, vomiting, foul smelling gas, and irregular bowel movements. 

Patients with gallbladder symptoms should be evaluated by a specialist and considered for laparoscopic cholecystectomy.