Disease Symptoms

The disorders affecting the gallbladder and the biliary tract are extremely common. The main role of the gallbladder  and biliary tract is to transport the bile into the intestine, which is essential for the digestion and absorbtion of fat. The symptoms of gallbladder disease are determined not only by the disease but also by the impact of the disease on normal digestion.

The most common gallbladder disorder is represented by gallstones, and some studies studies performed in the USA and Europe, have shown that about 15% of adults have gallstones. Most people with gallstones do not have any symptom (about 60%), in up to 30% of the people biliary colic or chronic cholecystitis will occur, and almost 15%  will develop acute complications. The main cause of all the clinical features of gallstone disease is represented by the obstruction of the biliary tract, obstruction which may occur at any level of biliary tract ( the cystic duct, common hepatic duct, common bile duct or ampulla of Vater).

The symptoms occur due to the contraction of the gallbladder during a transient obstruction by gallstones, but a persistent obstruction  leads to an inflammation or an infection of the gallbladder leading to consequent acute colecystitis. Biliary colic represents the common symptom of gallbladder disease and it presents as an intermittent pain which occurs in the right-upper quadrant. The other symptoms may be  nonspecific and include: nausea and vomiting .

Chronic cholecystitis refers to the "nonacute" symptoms determined by the presence of gallstones over a longer period of time (days or even years). Biliary pain is represented  typically by a steady ache in the epigastric region or in hte right upper quadrant, with a sudden onset.  Nausea and vomiting may occur, as well as  nonspecific symptoms such as dyspepsia, fatty food intolerance, heartburn, bloating and flatulence.

Acute cholecystitis consists in the distention, inflammation, edema and secondary infection of the gallbladder, as a result of the obstruction of the biliary tract by gallstones, by cancer or  by sludge. The characteristic clinical feature of acute cholecystitis is the acute onset of pain in the right upper quadrant, lasting for several hours. The severity of the pain increases, and the pain tends to localize to the epigastrium or right hypochondrium radiating to the right lumbar, scapular areas.  Other common features are nausea, vomiting and mild fever and in some cases a mild jaundice may be observed.

Acute (suppurative) cholangitis is a life-threatening infection and inflammation of the biliary tract determined by choledocholithiasis. The classic clinical manifestation are Charcot's triad : abdominal pain,  fever and jaundice. This disorder is a medical/surgical emergency and if untreated it has a fast evolution towards sepsis, shock, and death.

Primary sclerosing cholangitis is an idiopathic condition  which consists in a chronic inflammatory fibrosis and consequent obliteration of the hepatic bile ducts. The clinical manifestations of primary sclerosing cholangitis are various and range from asymptomatic patients with abnormal levels of liver enzymes  to recurrent  fever,  abdominal pain, chills, and jaundice.