A diseased gallbladder is one that can no longer store or release bile properly, usually because of gallstones, chronic inflammation, or problems with how the organ contracts. The gallbladder is a small, pear-shaped organ tucked beneath your liver. Its job is to hold about half the bile your liver produces, then squeeze it into your small intestine when you eat to help break down fats. When something disrupts that process, the result is pain, digestive trouble, and sometimes dangerous complications.
What the Gallbladder Actually Does
Your liver constantly produces bile, a greenish-yellow fluid made of cholesterol, bile salts, and waste products. About 50% of that bile gets routed to your gallbladder for storage between meals. When food enters your small intestine, especially fatty food, the gallbladder contracts and pushes stored bile through a duct into the first section of the small intestine (the duodenum). Bile serves two purposes: it breaks down dietary fat so your body can absorb it, and it carries waste products out of the liver for elimination.
When any part of this system malfunctions, bile can back up, stagnate, or leak where it shouldn’t. That’s when the gallbladder becomes “diseased.”
Gallstones: The Most Common Problem
Gallstones form when substances in bile, usually cholesterol, crystallize into solid pieces. They range from tiny grains to golf ball-sized masses. Many people carry gallstones for years without symptoms. Problems start when a stone shifts and blocks one of the ducts that carry bile out of the gallbladder.
A stone lodged in the neck of the gallbladder triggers inflammation (cholecystitis). A stone that travels further can block the common bile duct, causing severe pain, yellowing of the skin, and duct infection. If a stone blocks the pancreatic duct instead, it can cause pancreatitis, a painful and potentially serious inflammation of the pancreas.
Acute vs. Chronic Inflammation
Gallbladder inflammation comes in two forms, and they feel quite different.
Acute cholecystitis hits suddenly. You’ll typically feel continuous, severe pain on the right side of your abdomen lasting hours, often with fever, nausea, and vomiting. The gallbladder swells and becomes tender. This is an urgent situation. Without treatment, complications can include tissue death inside the gallbladder wall (gangrene), a tear in the organ itself, or infection spreading into the abdominal cavity or bloodstream.
Chronic cholecystitis develops slowly over weeks to months. The pain is duller, centered in the right upper abdomen, and often radiates around to the mid-back or the tip of the right shoulder blade. Fatty foods can make it worse, but the intense post-meal episodes typical of acute attacks are less common. Fever is rare. Over time, repeated bouts of low-grade inflammation cause the gallbladder wall to thicken with scar tissue and fibrosis. In severe cases, the organ physically shrinks and becomes stiff, losing its ability to contract normally.
Biliary Dyskinesia
Not all gallbladder disease involves stones. Biliary dyskinesia is a condition where the gallbladder simply doesn’t empty well. The organ looks structurally normal on imaging but squeezes out too little bile when stimulated. This causes the same kind of upper-right abdominal pain and digestive discomfort as gallstones, which can make it tricky to diagnose without specific testing.
Gallbladder Polyps
Polyps are growths on the inner wall of the gallbladder, usually found incidentally during an ultrasound for something else. Most are harmless. Current guidelines recommend removal of the gallbladder when a polyp reaches 1 cm or larger because of increased malignancy risk, though research suggests truly cancerous polyps are uncommon even at that size and most malignant ones are 2 cm or larger.
What a Gallbladder Attack Feels Like
The hallmark symptom is pain under the right ribcage, right where the gallbladder sits. Attacks typically start 15 to 20 minutes after eating, particularly after greasy, oily, or fatty meals. The pain can last anywhere from 30 minutes to four hours. Some people describe it as a deep, squeezing pressure that wraps around to the back. Nausea is common. The pain may ease as the gallbladder relaxes or the stone shifts position, then return after the next meal.
Chronic gallbladder disease produces a subtler version of this pattern. Instead of dramatic attacks, you might notice persistent bloating, mild nausea after fatty foods, and a nagging ache in the right upper abdomen that never fully resolves.
How a Diseased Gallbladder Is Diagnosed
Ultrasound is the first-line imaging test. It can reveal gallstones, wall thickening, and fluid around the organ. A healthy gallbladder wall measures under 3 mm on ultrasound. Anything above that suggests inflammation. Mild thickening runs 3 to 4 mm, moderate is 5 to 6 mm, and severe is anything above 6 mm. Greater wall thickness generally correlates with more advanced disease.
When the ultrasound looks normal but symptoms persist, a HIDA scan can evaluate how well the gallbladder functions. During this test, a small amount of radioactive tracer is injected into a vein and tracked as it moves through the biliary system. After the tracer fills the gallbladder, a medication stimulates the organ to contract. A normal gallbladder ejects more than 30% to 35% of its contents. An ejection fraction below that range points toward chronic cholecystitis or biliary dyskinesia.
Treatment and What Comes After
Gallbladder removal (cholecystectomy) is the standard treatment for symptomatic gallbladder disease and the most common abdominal surgery in the United States, with over 1.2 million performed annually. Most procedures are done laparoscopically through a few small incisions, meaning shorter hospital stays and faster recovery compared to open surgery. Many patients go home the same day or the next.
You can live without a gallbladder. Your liver continues making bile, but instead of being stored and released in concentrated bursts, it drips continuously into your small intestine. Most people adjust without major issues, but roughly 10% to 15% of patients develop what’s called postcholecystectomy syndrome. Symptoms include intolerance to fatty foods, bloating, diarrhea, nausea, and intermittent abdominal pain. For most, these issues improve over time as the body adapts to continuous bile flow, though some people find they need to permanently reduce fat intake to stay comfortable.