Different Types of Gallbladder Disease
Whether you have recently been diagnosed with gallstones, sludge or biliary dyskinesia, it is important you are aware of your specific diagnosis and symptoms. See each type of gallbladder disease below. Please consult with your gastroenterologist for proper diagnosis and testing.
The term “porcelain” in the name is because the gallbladder becomes bluish and delicate due to calcium deposits inside the gallbladder wall. Typical treatment involves removal of the gallbladder. Most people with porcelain gallbladder are asymptomatic, so it is often found by accident. Porcelain gallbladder, like gallbladder cancer, is rare and a result of chronic inflammation. However, porcelain gallbladder is believed to be associated with an increased risk of gallbladder cancer.1,2
Gallbladder adenomyomatosis (GA) is a non-cancerous thickening of the gallbladder wall. It is more common than the previous two diseases and can be diagnosed with an ultrasound. The cause of GA is still not fully understood, although studies point toward a history of gallbladder stones and chronic inflammation. One type of GA has a higher association with cancer, but since GA is mostly harmless, removal of the gallbladder is only necessary if there are symptoms.3
Gallbladder polyps are growths inside the gallbladder wall. They are relatively common with 3-7% of the population having them. Like many other gallbladder diseases, polyps can be asymptomatic, so they are difficult to detect unless it’s by accident (for example, in an ultrasound or when the gallbladder is removed). Symptoms of polyps are similar to gallstones, which include nausea, vomiting and pain in the upper abdomen. If polyps are symptomatic or larger than 6 millimeters, they should be removed since they could mean greater cancer risk. Sometimes removal of the gallbladder is necessary as well.4-5
Gallstones are common and affect 10-20% of Americans. They are hardened deposits of bile that form in the gallbladder, ranging in size from a grain of sand to a golf ball. Like polyps, symptoms of gallstones include intense abdominal pain just under the ribs (called a “gallbladder attack”), vomiting and indigestion. These symptoms happen when a gallstone blocks a bile duct. However, many people have gallstones and don’t experience symptoms. They are usually found by accident due to another procedure.1,6
Gallstones can sometimes pass through with the help of medication or resolve on their own, but typically the gallbladder must be removed. The body can function without the gallbladder, but dietary modifications usually need to be made.1
There are two types of gallstones: pigment and cholesterol. It is possible to have both kinds. We’ll go into the difference below.
Pigment stones are a kind of gallstone made of a dark pigment called bilirubin. Risk factors for pigment stones include diseases like Crohn’s, sickle cell and cirrhosis. Pigment stones are also more common in Asian countries and are associated with parisites.1,6
These stones are lighter yellow-green in color. They are primarily made of hardened cholesterol. Risk factors like the typical Western high fat, low fiber diet, chronic dieting and rapid weight loss, obesity, diabetes, sedentary lifestyle and certain medications can lead to the formation of cholesterol gallstones.1,6
This condition slows the ability of the gallbladder to move bile into the bile ducts. It may also affect the sphincter of Oddi which allows bile to flow into the small intestine. Both issues can result in severe abdominal pain, especially after eating fatty meals. Treatment may involve gallbladder removal if the condition is severe. If the sphincter of Oddi is affected, medication or a surgical procedure called a sphincterotomy must be done to alleviate symptoms.7
A hyperkinetic, or overactive, gallbladder is rare and the opposite of biliary dyskinesia. Not much is known about what causes it, but it is diagnosed with a hepatobiliary iminodiacetic acid (HIDA) scan. This scan measures the how much of its contents the gallbladder releases at one time, or ejection fraction. An ejection fraction of >80% points to a hyperkinetic gallbladder. Symptoms include intense pain in the upper abdomen, chalky colored stools (indicating fat is not properly digesting), and other digestive issues. Treatment involves gallbladder removal. 8
Gallbladder cancer is rare in the U.S., but it is serious. Symptoms are vague, so it can be difficult to diagnose early. Risk factors include having gallstones, previous chronic infection, ethnicity, genetics, gender and increasing age.1
- Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-187. doi:10.5009/gnl.2012.6.2.172
- Jones MW, Weir CB, Ferguson T. Porcelain Gallbladder. In: StatPearls [Internet]. StatPearls Publishing; 2022.
- Bonatti M, Vezzali N, Lombardo F, et al. Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls. Insights Imaging. 2017;8(2):243-253. doi:10.1007/s13244-017-0544-7
- Andrén-Sandberg A. Diagnosis and management of gallbladder polyps. N Am J Med Sci. 2012;4(5):203-211. doi:10.4103/1947-2714.95897
- Kamaya A, Fung C, Szpakowski JL, et al. Management of incidentally detected gallbladder polyps: Society of Radiologists in Ultrasound consensus conference recommendations. Radiology. 2022;305(2):277-289. doi:10.1148/radiol.213079
- National Institute of Diabetes and Digestive and Kidney Diseases. Accessed November 14, 2022. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones
- Toouli J. Biliary dyskinesia. Curr Treat Options Gastroenterol. 2002;5(4):285-291. doi:10.1007/s11938-002-0051-9
- Williford ML, Fay KT, Simpson FJ, et al. Optimal management of the hyperkinetic gallbladder: A comparison of outcomes between operative and nonoperative approaches. Am Surg. 2021;87(6):903-909. doi:10.1177/0003134820966283