Liver Problems After Gallbladder Removal: What To Know?

While your organs are essentially all connected, some have a closer relationship with each other. One such pair is your liver and your gallbladder. To understand how these two are related, you must first understand how each of them functions.

Liver functions

Your liver functions primarily as a filter, cleaning your blood as it carries nutrients and toxins from your digestive tract to the rest of the body. Your liver works by removing or breaking down toxins that your gut has absorbed from the foods you eat.

Your liver also handles cholesterol and some hormones, activates important “helper molecules” called enzymes, and converts sugars into a form that can be stored, called glycogen.

Another key role of your liver is to create bile, a soap-like substance your body uses to help you digest fats. Bile produced by your liver is stored in your gall bladder and released on demand.

Gallbladder functions

Your gallbladder has the relatively simple role of being a storage vessel. The gallbladder is a small pouch that receives bile from the liver and holds onto it until you need it for digesting fats.

When you eat something fatty like fries or a burger, your gallbladder will release bile to help break down the fats so your body can absorb them.

Sometimes your gallbladder isn’t working quite right and needs to be removed. This operation is called a cholecystectomy.

The most common reason for gallbladder removal is gallstones. Gallstones are hard deposits that can occur in the gallbladder, encouraging infections or causing painful inflammation. They can also dislodge and get stuck elsewhere, preventing bile flow and constituting an emergency.

Liver problems after gallbladder removal 

If you’ve had your gallbladder removed via minimally invasive surgery (laparoscopic cholecystectomy), you may experience some liver-related problems as a result.

Jaundice

Jaundice is a condition in which the skin and the eyes become yellow due to a buildup of bilirubin, a yellow-orange pigment normally found in bile. There are many possible causes for jaundice in this context, including retained gallstones, strictures, or bile leak injuries post-surgery. Jaundice after a cholecystectomy occurs in roughly 1%–7% of individuals.¹

Biliary injury 

During gallbladder removal surgery, biliary injuries can happen, particularly from diathermy burns. As a result, bile fluid may occasionally leak out into the abdomen area, or there may be damage to the ducts or occlusion. However, this usually only occurs in approximately 1% of cases.²

These biliary injuries are classified based on their anatomical location and whether there is still communication with the common bile duct, as well as whether the injury is a bile leak or an occlusive injury (type B). This includes types A, B, C, D, and E.

Digestive issues (postcholecystectomy syndrome)

The main digestive issue you may experience after a cholecystectomy is difficulty digesting fatty foods, as well as abdominal pain. Without a gallbladder, your body doesn’t have a place to store bile in preparation for a fatty meal.

The liver does still produce bile and will secrete it, but the volume of bile available on demand is much less than it was when you had a gallbladder ready to stock up. Therefore, fatty meals will be hard on your digestive system as your gut struggles to metabolize fats.

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease is characterized by fat being stored in your liver in excess of 5% of total organ weight.³ The presence of fat in your liver can interfere with normal liver function, causing inflammation, digestive disruptions, and swelling of the abdomen. Although not perfectly proven, there appears to be an increased risk of NAFLD in people with cholecystectomy.⁴

Other issues

Other problems that can arise after a gallbladder removal include bowel injury, vascular injuries, and even bleeding.

If you have had your gallbladder removed, you may notice issues like diarrhea, abdominal pain, constipation, or difficulty digesting high-fat foods. Your doctor can give you medical advice on how to manage symptoms, and they can ensure there is nothing else going on apart from cholecystectomy side effects.

Symptoms of liver problems after gallbladder removal

After your gallbladder removal, you may experience postcholecystectomy syndrome (PCS). PCS is characterized by a range of gastrointestinal symptoms similar to those in a patient with an inflamed gallbladder prior to removal.

These symptoms include intolerance to fatty foods, nausea, vomiting, heartburn, jaundice, and abdominal pain. PCS symptoms may occur shortly after the gallbladder is removed or may take months to develop.

What causes liver problems after cholecystectomy?

Liver problems after the removal of the gallbladder may be the result of biliary injury (A, B, C, D, and E) or vascular injury during surgery. In some rare cases, bile leaks (A,  C, D) can also occur.

How to treat liver problems

The best way to treat liver problems depends on what exactly is causing the issue. A good rule of thumb is to make sure you eat a healthy diet of fruits and vegetables, stay away from too many high-fat foods like fries or potato chips, avoid drinking much alcohol, and get regular exercise.

Dietary changes

There are a number of dietary changes you can make to help keep your liver happy after you've had your gallbladder removed.

• Avoid high-fat foods: Bile is needed to digest fat, so if you don't have a stockpile of bile, fat may cause digestive upset. 

• Consume enough fiber: Fiber is a vital part of healthy digestion, providing bulk that your digestive tract uses to move everything along. Good sources of dietary fiber include fruits, vegetables, and whole grains like brown rice and wild rice.

The lowdown

Gallbladder removal is a safe procedure that may relieve you of the discomfort of an inflamed, blocked, or infected gallbladder, but you may have a few side effects as well. There are plenty of treatment options available to help you manage these symptoms and live a comfortable and happy life.

Frequently asked questions

Can removal of the gallbladder cause liver problems?

Yes, gallbladder removal can increase your risk of liver problems like NALFD. If you have had your gallbladder removed, you should ensure you eat a healthy diet to support your liver and other digestive organs.

Can having no gallbladder cause fatty liver?

Having no gallbladder won’t cause a fatty liver, but it does increase the risk of developing a fatty liver. High-fat foods may not be digested as easily and can cause digestive problems, such as diarrhea or constipation.

What causes liver pain after gallbladder removal?

There are several reasons why your liver might hurt after your gallbladder is removed, some more serious than others. If you’ve had a cholecystectomy and feel pain in your liver, you should speak to your doctor.

How do I keep my liver healthy after gallbladder removal?

You can keep your liver healthy after gallbladder removal by eating a healthy diet of fruits and vegetables, limiting high-fat foods and alcohol, and engaging in regular exercise.