Symptoms of an inflamed gallbladder can occur with gradual episodes or all at once.
Persistent gallbladder symptoms occur when gallstones partially obstruct the bile duct. Gallstones are solid formations of calcium salts or cholesterol. Inflammation of the gallbladder is usually classified as either chronic or acute, but the two conditions are closely related, especially in pediatric patients. In fact, most gallbladders removed in response to an acute attack show evidence of chronic inflammation, and some clinicians even regard acute inflammation of the gallbladder to simply be an exacerbation of chronic inflammation.
A gallbladder may also become chronically inflamed without gallstones, usually in debilitated patients or trauma victims. Although this condition is not as well understood, doctors believe a deficiency of the gallbladder prevents it from emptying bile, causing it to calcify. Regardless of what causes a chronically inflamed gallbladder, the inflammatory process remains the same.
The course of a chronically inflamed gallbladder may involve several acute episodes, or it may also be more gradual. According to the Mayo Clinic, the saturation of the gallbladder with bile, especially when it contains high levels of cholesterol, is believed to contribute to inflammation and gallstone formation. These processes lead to a chronic obstruction of the bile duct, a decrease in its ability to contract and the further accumulation and thickening of bile in the gallbladder. This allows the organ to become infected by bacteria that normally inhabit the intestines, such as Escherichia coli (E. coli) and members of the Bacteriodes genus.
This infection is what causes the gallbladder to become inflamed. It typically begins in the wall of the gallbladder, and may then spread to the surface where it can irritate nearby structures like the diaphragm and the intestines. This can cause tissue within the gallbladder to die, and in extreme cases may even cause the organ to rupture.
The most common initial sign of an inflamed gallbladder is pain that begins in the epigastric region and spreads to the entire right upper quadrant (RUQ) of the abdomen, according to University of Pennsylvania Health System. The pain may be intermittent at first, but it in nearly all cases it eventually becomes constant. The patient usually experiences nausea, vomiting and occasionally a fever. An inflamed gallbladder not caused by gallstones generally causes similar symptoms, but some patients may only experience fever along with the infection. A physical examination may show a fever and rapid heart rate along with the tenderness in the abdominal RUQ.
The symptoms of a chronically inflamed gallbladder are less specific, as outlined by the National Institutes of Health. Since the bile duct is not completely obstructed, the symptoms tend to be rather vague and may include belching, chronic indigestion, diarrhea, nausea and general abdominal pain. In many cases, a physical examination will reveal tenderness in the RUQ, but this is not universal. Chronically inflamed gallbladders usually occur in women, especially those over the age of 40. Not surprisingly, patients with a history of gallstones or acute attacks also have a higher risk of developing chronic inflammation.
Blood work is usually the first lab test doctors perform on patients suspected of having a gallbladder infection. An elevated white blood cell count is the primary sign of a general infection, and may be accompanied by high levels of liver enzymes, pancreatic enzymes and bilirubin.
The physician may then perform one or more of these imaging tests to confirm the diagnosis of an inflamed gallbladder:
Most people experience pain for a prolonged period of time before seeking treatment, even when they have a documented history of developing gallstones. Anytime symptoms of an inflamed gallbladder occur or reoccur, contact a health care provider.