What Is Acalculous Gallbladder Disease?

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Acalculous gallbladder disease is an inflammation of the gallbladder without the presence of gallstones.  The symptoms of acalculous gallbladder disease are similar to those of acute (sudden, severe) cholecystitis that results from gallstones. Acute cholecystitis is a condition involving a severe inflammation of the gallbladder, it is usually caused by gallstones, but not always. Acalculous means without stones (calculi).

The risk of acalculous gallbladder disease is raised if you have a contributing illness such as a long term illness, severe trauma (such as third-degree burns), or serious medical condition.

The condition can be chronic (slowly progressing with intermittent or vague symptoms) or acute (quick to develop, severe). Acalculous gallbladder disease is more common in people who are critically ill, such as those in the intensive care unit (ICU).

The complications of acalculous gallbladder disease can be very severe, therefore it is considered a potentially life-threatening disorder.

Woman with stomach ache lying on the sofa
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Acalculous Gallbladder Disease Symptoms

Symptoms of acalculous gallbladder disease can be difficult to differentiate from other inflammatory conditions of the gallbladder. Mild symptoms may include:

  • Belching
  • Nausea and vomiting
  • Food intolerance

Severe symptoms may develop abruptly, the onset of severe symptoms may include:

  • Severe right upper quadrant abdominal pain
  • Fever
  • Symptoms of acute cholecystitis (including nausea and vomiting, fever, chills, yellowish tinge to the whites of the eyes or skin, bloating of the abdomen, pain that typically occurs after a meal)
  • Distended gallbladder that the healthcare provider can palpate (feel) upon physical examination
  • Elevation of white blood cells (which is usually present, but not always)

A chronic (slow to develop) form of acalculous gallbladder disease can be present. In chronic acalculous cholecystitis, symptoms are more prolonged and may be less severe. Symptoms may also be more intermittent and vague. But in acute acalculous gallbladder disease, a person is very ill, may have septicemia (a bacterial infection in the bloodstream), and is often in an intensive care hospital setting. Often a person with acute acalculous gallbladder disease has been in the hospital for some type of serious illness or is recovering from major surgery.

Causes

There are many different underlying causes of gallbladder dysfunction, common causes include:

  • Fasting for long periods of time
  • Dramatic weight loss
  • Long periods of total parenteral nutrition (TPN), which is intravenous nutritional feeding and hydration
  • Gallbladder stasis (a condition involving a lack of gallbladder stimulation that leads to an increase in the concentration of bile salts and a build-up of pressure in the gallbladder)
  • Decreased function of gallbladder emptying
  • Hypokinetic biliary dyskinesia (impaired gallbladder emptying, which may result from many different factors)

Pathophysiology

The pathophysiology of a condition refers to how the body reacts or responds to the presence of a particular illness; it is often defined as the physiological (the functions of living organisms) process of a disease. The pathophysiology of acalculous gallbladder disease may involve various responses in the body, including:

  • Severe inflammation of the gallbladder
  • A build-up of pressure in the gallbladder from stasis (lack of normal flow) of bile
  • Ischemia (lack of adequate oxygenation) in the gallbladder wall
  • Bacterial growth in the gallbladder (which can occur when bile stops flowing properly)
  • Gangrene (local tissue death and decomposition/rotting and decay of tissue) of the gallbladder if the pressure is not relieved properly
  • Perforation (a hole in the wall of the gallbladder involving a collection of pus called a pericholecystic abscess)
  • Sepsis (severe infection of the bloodstream that can be fatal if not treated promptly)

Predisposing Factors

Predisposing factors are those that can make a person more susceptible to a specific illness; the predisposing factors for acalculous gallbladder disease include:

  • Noninfectious conditions of the liver and biliary tract (liver, gallbladder, and bile ducts that store and secrete bile)
  • Acute hepatitis (infection of the liver)
  • Other forms of hepatitis
  • Wilsons disease (a genetic disorder involving a harmful accumulation of copper in the body)
  • Gallbladder polyps (abnormal growths)
  • Systemic infectious diseases (infectious diseases that impact the entire body, such as bacteremia)
  • Viral infections such as Ebstein-Barr virus (EBV) or cytomegalovirus
  • Bacterial infections such as Group B Streptococcus infection
  • Severe physical trauma such as third-degree burns
  • Heart surgery
  • Abdominal surgery
  • Diabetes

Epidemiology

Epidemiology is the study of the incidence (and possible control of) specific diseases in certain populations, including geographic populations, age groups, male vs. female and more. The epidemiological factors for acalculous gallbladder disease include:

  • Acalculous gallbladder disease accounts for 10% of all cases of acute inflammation of the gallbladder (cholecystitis). It accounts for 5% to 10% of all cases of non-acute cholecystitis.
  • The male to female ratio of incidence of acalculous gallbladder disease is between 2 to 1 and 3 to 1.
  • The incidence of acalculous gallbladder disease is higher in those with human immunodeficiency virus (HIV) infection and other illnesses that suppress the immune system.
  • People that carry Giardia lamblia, (a parasitic infection, contracted from drinking water), Helicobacter pylori (a bacterial infection in the gastrointestinal tract that commonly causes stomach ulcers), and Salmonella typhi (a bacterial disease that causes typhoid fever, spread in food and water) also have an increased risk of developing acalculous gallbladder disease and other forms of inflammation of the gallbladder.

Diagnosis

A liver function test (involving blood samples sent to the lab) is taken to check for elevated aminotransferases, alkaline phosphatase, and bilirubin levels.

An ultrasound is often used to diagnose acalculous gallbladder disease. The ultrasound may show thickening of the gallbladder wall. If the test results from ultrasound are uncertain, the test of choice is a cholescintigraphy nuclear scan (HIDA) with the administration of cholecystokinin (CCK).

What Is a Cholescintigraphy Nuclear Scan (HIDA)?

This diagnostic test involves a radioactive tracer that is injected into a vein in the arm. The tracer then travels through the bloodstream and into the liver. The cells in the liver that produce bile take up the tracer; the tracer then travels into the bile and gallbladder, then finally into the small intestine. As the tracer travels through the gallbladder, computer images are taken. Then cholecystokinin stimulates the gallbladder to empty; the HIDA scan will show the inability of the gallbladder to effectively empty when acalculous gallbladder disease is present.

Differential Diagnosis

Differential diagnosis involves distinguishing a particular disease from others with similar signs and symptoms. When a person has acalculous gallbladder disease, there are several other disorders that may need to be ruled out, these include:

  • Acute cholangitis (an infection in the bile ducts)
  • Acute cholecystitis
  • Pancreatitis (inflammation of the pancreas)
  • Hepatitis (inflammation of the liver)

Treatment

Treatment of acalculous gallbladder disease depends on how severe the condition is. A person who has severe symptoms (such as septicemia) will initially need to be stabilized. Relieving the pressure that has built up in the gallbladder will be a top priority. This can be accomplished by the placement of a drainage tube in the gallbladder. If a bacterial infection is present, antibiotics will be given to help stabilize the patient.

If the condition is chronic, and the person with inflammation of the gallbladder (acalculous gallbladder disease) is stable, however, it will be treated the same as an inflammation of the gallbladder with stones (cholelithiasis). This will involve traditional (also called open) surgery, involving a large incision to expose the surgical site or laparoscopic surgery (a surgical technique that is performed through very small incisions, using an instrument called a laparoscope) to remove the gallbladder (cholecystectomy).

If a person develops a gangrenous gallbladder, an emergency cholecystectomy will be performed right away.

Standard treatment of acalculous gallbladder disease usually involves giving broad-spectrum antibiotics (antibiotics that can inhibit the growth of or kill a wide variety of different pathogens). If the person is too unstable for surgery, percutaneous drainage may be needed before the cholecystectomy can be performed.

According to Radiology Info.org for Patients, “Percutaneous abscess drainage uses imaging guidance to place a needle or catheter through the skin into the abscess to remove or drain the infected fluid It offers faster recovery than open surgical drainage.” 

The healthcare provider may perform an endoscopy (a surgical procedure involving a thin tube with a camera) to surgically insert a stent to decompress the pressure. The purpose of this is to lower the risk of serious complications such as perforation, gangrene, or sepsis.

A Word From Verywell

Acalculous gallbladder disease is a very serious illness that has a high mortality (death) rate. According to Cleveland Clinic, "The outcome of patients with acalculous cholecystitis [gallbladder disease] depends to a large extent on the underlying [cause of the] illness." The mortality rate for acalculous gallbladder disease—once perforation occurs—can be as high as 30%.

People who survive acalculous gallbladder disease will have a long road to recovery which may take months. It’s important to seek immediate medical attention anytime you have symptoms of gallbladder disease.

Those with diabetes or other conditions that make a person high risk should pay particularly close attention to any signs or symptoms of gallbladder disease (such as severe upper right quadrant abdominal pain, yellowish tinge to the whites of the eyes or skin, nausea and vomiting and more).

The most common serious complication that can occur from gallbladder disease— particularly for those in a high-risk category such as older people or those with diabetes— is gangrenous cholecystitis. This is a medical emergency requiring immediate surgical removal of the gallbladder.

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