Gallbladder Disease: Symptoms, Diagnosis, and When You Need Surgery

Gallbladder disease is one of the most common reasons patients end up in a surgeon’s office in the United States. Each year, more than 700,000 cholecystectomies — gallbladder removal surgeries — are performed, making it one of the most frequently performed operations in American surgery. And for good reason: untreated gallbladder disease can progress from occasional discomfort to serious, life-threatening complications.

If you’ve been experiencing right-sided abdominal pain after eating, pain that radiates to your right shoulder or back, nausea, bloating, or episodes of more severe pain that come and go — your gallbladder may be the source. Understanding what gallbladder disease is, what it feels like, and how it’s treated is the first step toward getting real relief.

At Sulphur Surgical Clinic, our board-certified general surgeons have treated gallbladder disease for patients throughout Southwest Louisiana for over 50 years. Whether you’ve been told you have gallstones and aren’t sure what to do next, or you’re in the middle of a flare and need answers quickly — we’re here.

What Is the Gallbladder?

The gallbladder is a small, pear-shaped organ tucked beneath the right lobe of the liver. Its primary function is to store and concentrate bile — a digestive fluid produced by the liver that helps break down fats in the small intestine.

When you eat — particularly a fatty meal — the gallbladder contracts and releases bile through the cystic duct into the common bile duct, which carries it into the duodenum (the first part of the small intestine). In a healthy gallbladder, this process happens smoothly and without symptoms.

When the gallbladder is diseased — due to stones, inflammation, infection, or dysfunction — this process is disrupted, and symptoms follow.

Types of Gallbladder Disease

Gallstones (Cholelithiasis)

Gallstones are hardened deposits of bile components that form within the gallbladder. They are the underlying cause of most gallbladder disease. There are two main types:

Cholesterol gallstones — the most common type (accounting for roughly 80% of gallstones in the US). They form when bile contains more cholesterol than can be kept in solution, leading to crystal formation and progressive stone growth.

Pigment gallstones — composed primarily of bilirubin and calcium. More common in patients with cirrhosis, hemolytic anemias (such as sickle cell disease), or biliary tract infection.

Gallstones range from the size of a grain of sand to the size of a golf ball. They can be solitary or number in the hundreds. Paradoxically, very small stones (microlithiasis) can be more symptomatic than large ones — because small stones are more likely to escape the gallbladder and become lodged in the bile ducts.

Risk factors for gallstone formation include:

Female sex — estrogen influences cholesterol metabolism and gallbladder motility
Age — risk increases with age
Obesity — increases cholesterol saturation of bile
Rapid weight loss — mobilizes cholesterol and can supersaturate bile
Pregnancy — progesterone slows gallbladder emptying
Certain medications (oral contraceptives, hormone replacement therapy, some cholesterol-lowering drugs)
Family history
Diabetes and insulin resistance
Diet high in refined carbohydrates and saturated fats

Biliary Colic

Biliary colic is the term for the symptomatic pain episode caused by a gallstone temporarily obstructing the cystic duct. When the gallbladder contracts — typically after a meal — a stone can be pushed against the duct opening, causing a sudden onset of visceral pain.

Characteristics of biliary colic:

Located in the right upper quadrant (RUQ) or epigastrium (upper middle abdomen)
May radiate to the right shoulder blade or mid-back
Typically severe, crampy or constant in character — not truly colicky in the medical sense despite the name
Onset one to two hours after a meal, particularly a fatty or rich meal
Lasts 30 minutes to several hours, then resolves as the stone falls back or passes
Associated nausea and sometimes vomiting
Fever and persistent pain are not typical of simple biliary colic — these suggest progression to cholecystitis

Biliary colic typically recurs. Once a patient has had a symptomatic gallstone episode, the risk of future episodes is significant, and the risk of progression to acute cholecystitis is meaningful. Elective cholecystectomy is generally recommended after the first or second symptomatic episode.

Acute Cholecystitis

Acute cholecystitis is inflammation of the gallbladder — most commonly caused by a gallstone obstructing the cystic duct and remaining lodged there (rather than falling back, as in biliary colic). The sustained obstruction leads to increased gallbladder wall pressure, ischemia, secondary bacterial infection, and frank inflammation.

Symptoms of acute cholecystitis:

Persistent right upper quadrant pain — typically more severe and sustained than biliary colic
Fever and chills — often present, distinguishing cholecystitis from simple biliary colic
Nausea and vomiting
Tenderness with deep palpation under the right rib cage; positive Murphy’s sign (cessation of inspiration with deep RUQ palpation)
Elevated white blood cell count on blood work

Acute cholecystitis is typically treated with IV antibiotics and hospitalization, followed by laparoscopic cholecystectomy — either during the same admission (early surgery, within 72 hours) or on an elective basis after the acute inflammation has resolved, depending on the clinical situation.

Delayed or untreated acute cholecystitis can progress to gangrenous cholecystitis (necrosis of the gallbladder wall), perforation, or pericholecystic abscess — serious complications that significantly increase surgical risk.

Chronic Cholecystitis

Chronic cholecystitis develops when repeated episodes of biliary colic or low-grade inflammation gradually damage and scar the gallbladder wall. The gallbladder becomes thickened, fibrotic, and may lose its normal contractile function.

Patients with chronic cholecystitis often have a long history of episodic right upper quadrant discomfort, fatty food intolerance, bloating, and nausea. Ultrasound may show gallstones, gallbladder wall thickening, and pericholecystic fluid.

Cholecystectomy is definitive treatment.

Choledocholithiasis (Stones in the Common Bile Duct)

When gallstones migrate from the gallbladder into the common bile duct, they can obstruct the flow of bile from the liver into the intestine. This condition — choledocholithiasis — causes more severe symptoms than gallbladder stones alone:

Jaundice (yellowing of the skin and eyes)
Dark urine and pale stools
Severe upper abdominal pain
Elevated liver function tests and bilirubin on blood work

Choledocholithiasis can also lead to cholangitis — a dangerous infection of the bile duct system — or gallstone pancreatitis, when a stone obstructs the pancreatic duct at the ampulla of Vater.

Management of choledocholithiasis typically involves ERCP (endoscopic retrograde cholangiopancreatography) to remove the common bile duct stone, followed by laparoscopic cholecystectomy to remove the gallbladder and prevent recurrence.

Gallstone Pancreatitis

Gallstone pancreatitis occurs when a small gallstone migrates into the common channel where the bile duct and pancreatic duct join before emptying into the duodenum, triggering obstruction and inflammation of the pancreas. It is one of the most common causes of acute pancreatitis in the US.

Patients present with severe upper abdominal or mid-abdominal pain radiating to the back, nausea and vomiting, and elevated amylase and lipase levels. Most cases are mild and resolve with supportive care; severe pancreatitis can be life-threatening.

After resolution of pancreatitis, early cholecystectomy during the same admission is recommended to prevent recurrence — which is both common and potentially severe.

Biliary Dyskinesia

Not all symptomatic gallbladder disease involves stones. Biliary dyskinesia describes abnormal gallbladder function — specifically, impaired gallbladder contractility — in the absence of gallstones.

Patients experience episodic right upper quadrant pain, nausea, and fatty food intolerance that mirrors symptomatic gallstone disease. Ultrasound is normal (no stones). Diagnosis is established by HIDA scan with CCK stimulation — a nuclear medicine study that measures gallbladder ejection fraction. An ejection fraction below 35–40% is generally considered abnormal.

Cholecystectomy is typically curative for biliary dyskinesia with low ejection fraction and characteristic symptoms. The decision to operate is made carefully, as outcomes are less predictable than for stone disease.

How Is Gallbladder Disease Diagnosed?

Abdominal ultrasound is the first and most important imaging study for suspected gallbladder disease. It is highly accurate for detecting gallstones (sensitivity >95%), gallbladder wall thickening, pericholecystic fluid, and biliary dilation. It is non-invasive, radiation-free, and widely available.

Blood work — including a complete metabolic panel (liver function tests, bilirubin), CBC (white blood cell count), and amylase/lipase — provides important information about the presence of infection, bile duct obstruction, and pancreatic involvement.

HIDA scan (hepatobiliary iminodiacetic acid scan) — a nuclear medicine study that evaluates gallbladder function and bile flow. Used when ultrasound is inconclusive, when biliary dyskinesia is suspected, or when acute cholecystitis is suspected but ultrasound is equivocal.

CT scan — not the first choice for gallbladder disease (it misses most cholesterol gallstones), but useful for evaluating complications such as perforation, abscess, or pancreatitis.

MRCP (magnetic resonance cholangiopancreatography) — a non-invasive MRI-based imaging study that provides detailed visualization of the bile ducts. Used to evaluate for choledocholithiasis before or in lieu of ERCP.

When Does Gallbladder Disease Require Surgery?

Cholecystectomy — surgical removal of the gallbladder — is indicated when:

Symptomatic gallstones have caused biliary colic, acute cholecystitis, or other complications
Gallstone pancreatitis has been diagnosed
Choledocholithiasis has been treated by ERCP and cholecystectomy is recommended to prevent recurrence
Biliary dyskinesia with low ejection fraction and characteristic symptoms
Gallbladder polyps meeting criteria for increased malignancy risk (particularly polyps ≥1 cm or growing on serial imaging)
Porcelain gallbladder (calcification of the gallbladder wall) when associated with high-risk features

The standard surgical approach is laparoscopic cholecystectomy — a minimally invasive procedure performed through small incisions using a camera and specialized instruments. (For a detailed discussion of the procedure and Sulphur Surgical Clinic’s use of advanced ICG fluorescence imaging technology to maximize safety, see Part 2 of this series.)

Frequently Asked Questions About Gallbladder Disease

Can gallstones be dissolved with medication? Oral bile acid therapy (ursodeoxycholic acid) can dissolve small cholesterol gallstones over months to years, but recurrence after stopping treatment is common. It is generally reserved for patients who are not surgical candidates and is rarely used in current practice.

What happens if I just leave my gallstones alone? Asymptomatic gallstones — stones that have never caused symptoms — are often managed with observation. However, once gallstones have caused symptomatic episodes, the risk of recurrence and complications is significant. Most symptomatic patients are better served by elective cholecystectomy than by waiting for the next attack.

Is the gallbladder necessary? The gallbladder is not essential for normal digestion. After cholecystectomy, bile flows continuously from the liver into the small intestine rather than being stored and released in boluses. Most patients adapt well; a small percentage experience loose stools, particularly after fatty meals, which typically resolves over weeks to months.

How long is recovery from gallbladder surgery? Laparoscopic cholecystectomy is typically an outpatient procedure. Most patients return to light activity within a few days and to normal activity within one to two weeks.

Do I need a referral to see a surgeon at Sulphur Surgical Clinic? No. You can call (337) 527-6363 directly to schedule a surgical evaluation. If you have imaging or blood work results, bring them to your appointment. If you are experiencing severe pain, fever, or jaundice, seek immediate evaluation.

Expert Gallbladder Care — Right Here in Southwest Louisiana

Gallbladder disease is extremely common, but it is not something to manage indefinitely with pain and dietary restriction. With minimally invasive surgery, most patients go home the same day and are back to their normal lives within a week or two.

Sulphur Surgical Clinic has been providing expert surgical care for gallbladder disease throughout Calcasieu, Beauregard, Allen, and Cameron parishes for over 50 years. Our surgeons use the latest technology — including advanced intraoperative imaging — to make the procedure as safe as possible.

Call (337) 527-6363 to schedule your gallbladder evaluation. No referral required.

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Word count: ~1,800 words