What Is the Gallbladder?

The gallbladder is a small, pear-shaped organ located under the liver on the right side of your abdomen. Although it’s only about half the size of your fist, it plays an important role in digestion.

Its primary job is to store and concentrate bile, the digestive fluid produced continuously by the liver.
Bile helps your body:

• Break down and absorb dietary fats

• Eliminate waste products, including toxins from red blood cell breakdown

Because the liver makes far more bile than the body needs at one time, the gallbladder acts as a storage tank, releasing extra bile after you eat-especially meals that contain fat.

Important: The gallbladder does not make bile-it only stores and releases it.

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Common Gallbladder Problems

Most people don’t think about their gallbladder until symptoms begin. The most common issue is gallstones, which can block the normal flow of bile.

Gallstones (Cholelithiasis)

Gallstones are hardened deposits, usually yellowish, that form when bile becomes imbalanced. They can be tiny grains of sand or grow to several inches (“gall-boulders!”).

A person may have one stone or thousands.

Typical Gallstone Symptoms

• Right upper abdominal or upper-middle abdominal pain

• Pain that comes in waves or stays constant

• Pain after eating, especially fatty foods

• Nausea, bloating, or belching

• Night-time attacks that wake you from sleep

• Symptoms lasting minutes, but sometimes hours, if the blockage doesn’t resolve

As gallbladder disease progresses, symptoms often become more severe and more frequent. Many patients eventually end up in the ER for pain control.

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Why Rapid Weight Loss Causes Gallstones

One of the strongest risk factors for gallstones is rapid weight loss, especially after bariatric surgery (gastric sleeve, SADI-S, gastric bypass, etc.).

Here’s why:

1. Surge of Cholesterol Into Bile

Rapid weight loss breaks down stored fat quickly.
This releases free fatty acids, which the liver converts into cholesterol.

That cholesterol is then secreted into bile, causing bile to become oversaturated-perfect conditions for cholesterol-based gallstones to form.

2. Reduced Gallbladder Contracting (“Stagnant Bile”)

After bariatric surgery, patients:

• Eat less

• Eat less fat

• Consume fewer total calories

Normally, eating fat triggers gallbladder contractions. With less dietary fat, the gallbladder doesn’t squeeze often, and bile sits stagnant.
Stagnant bile thickens into sludge, which leads to stone formation.

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Biliary Dyskinesia: Gallbladder Symptoms Without Stones

Another common gallbladder condition, especially after bariatric surgery, is biliary dyskinesia.

This condition produces the same symptoms as gallstones, but without actual stones being present.

What Is Biliary Dyskinesia?

Biliary dyskinesia occurs when the gallbladder becomes weak and fails to contract effectively. Bile becomes trapped and the gallbladder becomes distended, causing pain similar to gallstone attacks.

Why It Happens After Bariatric Surgery

The gallbladder is a muscular organ.
When you eat less dietary fat after surgery, the gallbladder contracts less.

Like any muscle:

• Less use = more weakness

• Over time, the gallbladder becomes so weak it cannot empty well

Diagnosis: The HIDA Scan

A HIDA scan (hepatobiliary iminodiacetic acid scan) measures how well the gallbladder releases bile.

• An ejection fraction (EF) below 35% is considered abnormal

• This indicates poor gallbladder motility and supports a diagnosis of biliary dyskinesia

Importantly, you can have:

• Normal ultrasound

• No gallstones

• Ongoing severe symptoms

• And still have gallbladder disease

This is why the HIDA scan is crucial.

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When to See a Surgeon

If you're experiencing repeated upper abdominal pain, nausea after eating, or suspected gallbladder attacks, you should be evaluated promptly. Gallbladder disease does not improve on its own.

At Texas Center for Bariatrics & Advanced Surgery, Dr. Joe Cribbins and Dr. Chen specialize in minimally invasive and robotic gallbladder removal with:

• Tiny incisions

• Faster recovery

• Less pain

• Quicker return to normal activity

Call us at 214-501-1333 for a consultation ti discuss your gallbladder needs.