February 7, 2023

Gallbladder Removal Singapore: What are the First Signs of a Bad Gallbladder?

The Gallbladder is a small sac-like organ that stores and concentrates bile made by the liver. Bile is composed of water, electrolytes, conjugated bilirubin, cholesterol, phospholipids, bile salts and other organic molecules, including pigments such as bilirubin. The bile is secreted from the liver to help with digestion, especially of fats. 

What are the First Signs of a Bad Gallbladder?

The decision to remove your gallbladder will only be reached when your doctor is convinced that it’s the only way to improve your quality of life. See what to expect after gallbladder removal among other basics on this page: https://drganesh.sg/gallbladder-removal-can-i-still-live-a-normal-life-after-surgery/. The most common first signs associated with a bad gallbladder include:

  • Pain in the right upper abdomen (under ribs) that radiates into the shoulder on the same side as pain in the back in the left shoulder blade area. Pain can be mild or severe, and it can come and go.
  • Nausea and vomiting: Nausea and even vomiting can occur, especially after eating greasy or fatty foods.
  • Belching frequently: Belching may be a sign of excessive gas in the stomach and intestines.
  • Indigestion with nausea and vomiting: Symptoms such as indigestion result from backflow of acid from the stomach to the throat.
  • Jaundice: This is defined by the yellowing of your skin and eyes.
  • Fever or chills: Fever and chills may develop in the case of an infection in the gallbladder.
  • Darkening of urine: This sign suggests that bilirubin (a product excreted by the liver) has leaked into the urine because something isn’t working correctly in either liver or bile ducts. If you notice dark, tea-colored urine, contact your doctor immediately as this can be a symptom of several serious conditions such as hepatitis, cirrhosis, heart failure, and even cancer.

What are the Potential Complications of a Bad Gallbladder?

Diseases that affect the gallbladder are generally classified as gallbladder disease. Here are some of the more common diseases that can affect the gallbladder:

  • Gallstones

Gallstones are made up of concentrated bile. They are often found during routine screening, and it is thought that 10 to 15 percent of the adult population has them; however, most people with gallstones do not experience any symptoms. Gallstones vary considerably in size (from as small as a grain of sand to about the size of a golf ball) and can vary widely in terms of number (ranging from one to hundreds). 

Gallstones form when there is an imbalance between bile production by the liver and gallbladder storage of bile. Bile contains lecithin (which is composed mainly of cholesterol), bilirubin, bile salts, and water. Bile passes from the liver to the gallbladder and is stored there in preparation for when it will be needed. If you eat a high cholesterol diet, or if your body does not properly digest fats (due to enzyme deficiency or low stomach acid), toxins may form within the gallstones.

  • Cholecystitis (Inflammation of the Gallbladder)

Problematic bile can cause inflammation of the gallbladder, which is called cholecystitis. The pain associated with this condition typically begins suddenly and is followed by nausea and vomiting. It can also lead to jaundice and fever. This type of infection is more common in people who have had their gallbladders removed since the gallbladder’s presence usually serves to protect the liver against bile by-products.

  • Choledocholithiasis (Abnormal Gallstones in Bile Ducts)

Gallstones can get stuck at different places along the bile duct, which causes further complications. One of these problems is choledocholithiasis, which occurs when gallstones block one or both of the main bile ducts that lead out of the liver and into the small intestine. When this happens, bile backs up into the liver, causing inflammation that can become chronic if not treated right away. This condition may also cause jaundice or fever because bilirubin leaks back into your bloodstream due to damaged bile ducts.

  • Perforation of Gallbladder

The gallbladder is made up of three layers: mucosa, muscularis, and serosa. A gallstone passing through the cystic duct can cause the gallbladder wall to become inflamed. If this situation worsens, it can lead to perforation of the gallbladder wall into either the abdominal cavity or, even more dangerous, into the chest. This condition can be life-threatening if not immediately treated with surgery. If you have already had your gallbladder removed, there may still be some chances that stones will develop again in the liver or bile ducts (depending on whether or not these were removed as well).

  • Sludge (a Mixture of Cholesterol and Bile Salts)

Sludge is a term used to describe accumulations of cholesterol, calcium bilirubinate (which is an insoluble substance created when the liver breaks down old red blood cells), or any combination of these. Sludge can’t pass through the common bile duct that leads out of the liver into the small intestine, so it tends to build up in your gallbladder over time until it blocks the outlet and causes inflammation. This condition does not typically cause symptoms on its own, but if you have had your gallbladder removed and sludge is found, it may require an intervention such as surgery or ERCP to remove it.

When is Gallbladder Removal Necessary?

Usually, if you experience symptoms of Cholecystitis due to gallstones, ERCP is the first course of action. If stones are detected, they are usually removed via ERCP or surgery.

If you develop jaundice without having access to appropriate testing (i.e., cholelithiasis cannot be diagnosed by endoscopic retrograde Cholangiopancreatography), it might be wise to consider ultrasound or abdominal CT scan to see if your gallbladder has already been perforated and/or infected with sludge.

Surgery for removal of the entire gallbladder might become necessary when all conservative courses of action have failed, but this decision should not be taken lightly because severe postoperative complications can arise. If you are not in any pain (note: this does not include dull ache), the gallbladder can typically be removed later if it is suspected of causing harm to other vital organs, such as the liver or bile ducts. 

The main concern regarding removing a large gallstone that has already migrated into either the hepatic duct or common bile duct is an increased risk of infecting your bloodstream with bacteria. Bacteria tend to multiply more readily in dead tissue, so taking out the infected organ might prevent further damage from spreading throughout your body.

Before deciding whether or not surgery should be performed for what seems like chronic cholecystitis, consider these situations:

  • Frequent episodes of pain/irritability
  • Gallstones are not detectable in ultrasound/x-ray
  • Perforation of the gallbladder, likely due to sludge or one of the other complications of cholecystitis mentioned above.
  • Signs of jaundice resulting from complete blockage of the bile ducts by either gallstones or sludge.
  • Presence of liver disease, including cirrhosis, hepatitis, etc.
  • History of chronic pancreatitis related to cases where stones have been detected in either the pancreatic or common bile ducts.

Final Thoughts

There are several reasons why you might need to remove your gallbladder, but the only way to know for sure is by consulting a surgeon or gastroenterologist. An overnight stay at a hospital with immediate access to ERCP and/or surgery will usually determine whether or not aggressive treatment is needed.

Do you experience any symptoms which you think could be attributed to a bad gallbladder? It would be best to see a doctor now. Call us now to make an appointment. CALL 24/7 for your initial consultation at  6255 1234.

Dr Ganesh (General Surgeon in Singapore) – Endoscopy, Colonoscopy, Gastroscopy
Suite 1 #05-23B, Mount Elizabeth Novena Specialist Centre, Singapore 329563
+65 6255 1234
https://drganesh.sg