WHAT IS A PORCELAIN GALLBLADDER?
Porcelain gallbladder is a gallbladder that has become calcified. It is also known as cholecystopathia chronica calcarea – or the chronic condition of calcium in the gallbladder and also as calcifying cholecystitis – inflammation of the gallbladder resulting in calcification. It is a gallbladder disease in which all the layers - mucosa, submucosa, and glandular spaces including the Rokitansky-Aschoff sinuses are extensively covered by accumulated calcium flakes or plaques. Over time, this condition prevents the organ from performing its functions. It hardens and can’t contract anymore.
Although porcelain gallbladder is rare, it should not be taken lightly since it is considered a precancerous lesion. The direct association between gallbladder cancer and porcelain gallbladder is still a highly debated matter. However, there have been studies showing that 22-30% of the patients diagnosed with a porcelain gallbladder have developed a gallbladder adenocarcinoma. Generally, there is a 1-6% incidence of cancer in patients who are diagnosed with a porcelain gallbladder.
WHAT CAUSES PORCELAIN GALLBLADDER?
There are numerous hypotheses on what causes porcelain gallbladder. Below are some of the evidence-based claims from various studies and clinical assessment:
- Gallbladder inflammation
- Calcium metabolism disorders
- Gallstones or Cholelithiasis
The formation of stony concretions of cholesterol, bilirubin or other particles inside the gallbladder is the most commonly cited cause of porcelain gallbladder. Aside from that, it can also lead to the development of other conditions (discussed below) that, in turn, may also cause porcelain gallbladder.
If these gallstones block the bile duct or other parts of the biliary system, bile flow will be disrupted. Long-term inability of the gallbladder to perform its function may lead to eventual calcification.
- Inflammation of the Gallbladder or Cholecystitis
There are a few ways that inflammation can manifest within the biliary tract. The cystic ducts or the Rokitansky-Aschoff sinuses can be blocked and inflamed. Even the gallbladder wall, can be swollen by constant irritation brought about by gallstones rubbing against it. In extremely rare cases, this may even lead to intramural bleeding of the gallbladder wall. The remote possibility of hemorrhaging in the gallbladder may also be caused by trauma, hemophilia or cystic artery aneurysm.
Inflammation within the biliary system leads to blockade of circulation channels like the bile ducts and blood vessels. Once this happens, the bile stagnates, the pressure inside the gallbladder increases and calcium carbonate salts crystallize within the gallbladder forming gallstones. This same series of events also supports the formation of calcium deposits within the gallbladder walls leading to porcelain gallbladder.
- Calcium Metabolism Disorders
Another possible reason for the development of porcelain gallbladder is the presence of abnormal levels of calcium in the body as well as the inability of some people to process and direct calcium to the areas where it is needed and away from the areas it is not. Some studies show that those with hypercalcemia and primary hyperparathyroidism have greater risk of developing gallstones and accumulating calcium deposits in the body especially in the kidney and other nearby organs. Hyperparathyroidism is caused by overactive parathyroid glands which lead to high levels of calcium in the bloodstream or hypercalcemia.
Vitamin D3 and vitamin K2 deficiency could possibly contribute to the formation of porcelain gallbladder since vitamins D3 and K2 work together in ensuring proper distribution of calcium to areas of the body that need it like the bones and teeth. They also act as a guard to make sure that certain organs do not get an excessive calcium supply and do not accumulate calcium plaques. When there are not enough of those vitamins in the body, there is more chance for calcium to build up and deposit in the arteries and joints as well as to form stones in the kidneys and gallbladder. Calcium precipitation in the gallbladder lumen (the sac itself) leads to gallstone formation, while calcium precipitation within the gallbladder walls is believed to be a prelude to a porcelain gallbladder.
A rare speculative cause of porcelain gallbladder, giardiasis does not have a wide array of related literature and research to verify its accuracy. Giardia is an infection of the digestive system caused by the parasite Giardia lamblia or Giardia duodenalis . Giardia takes hold in the intestines but in very rare instances, can also spread to the biliary and pancreatic ducts. This may cause inflammation of the gallbladder and other nearby organs.
SYMPTOMS OF PORCELAIN GALLBLADDER
There are usually no symptoms of porcelain gallbladder. This means that a person with a calcified gallbladder may not exhibit indicators of a gallbladder disease for a long period of time. Diagnosis is therefore not easy because it is often asymptomatic. It may just be incidentally seen on abdominal x-rays, sonogram or other types of imaging. The few cases that do report symptoms have been:
- Abdominal pain
- Weight loss
- A palpable mass in the right upper abdomen
DIAGNOSIS OF PORCELAIN GALLBLADDER
To confirm the presence of a porcelain gallbladder, a few tests may be recommended. Plain abdominal radiographs or x-rays are often enough to visually confirm presence of porcelain gallbladder. However, some medical professionals choose to use CT scanning for superior sensitivity and definition.
Porcelain gallbladder often looks like an oval or pear-shaped assembly of calcium plaques in the right upper quadrant or right mid-abdomen. Unlike a cyst or stone calcification, porcelain gallbladder would be irregularly shaped and discontinuous. Without proper and accurate imaging , the appearance of porcelain gallbladder may be mistaken for the rim calcification of large solitary calcified gallstones.
CT scanning for porcelain gallbladders can also visually confirm whether any complications such as carcinoma, have already manifested. Observing the calcification pattern of the gallbladder is a good indicator for the risk of gallbladder cancer. Certain studies show that those patients with incomplete calcification have a higher probability of developing cancer than one that is totally calcified. If malignant changes have occurred in the gallbladder, doctors may require an angiogram before surgery. This process allows a closer analysis of the arterial system and shows whether blockages are present.
WHAT ARE THE RISK FACTORS FOR PORCELAIN GALLBLADDER?
Although the exact cause of porcelain gallbladder is not yet known, studies show that certain factors can increase the likelihood of its development. Some of the risk factors include:
- Genetics - Those with family history of gallbladder problems are more likely to develop gallbladder-related diseases.
- Age - The average age at which this condition is diagnosed is 54 years, with a common patient age range between 38 and 70 years.
- Gender - Porcelain gallbladder is up to 5 times more common in women than in men.
- Ethnicity - Another study suggested that ethnicity may influence the rate of porcelain gallbladder which leads to cancer, with a higher rate found in Latin America and Asia than in North America.
- Existing gallbladder conditions like gallstones or chronic gallbladder inflammation
- Existence of calcium-related disorders
TREATMENT FOR PORCELAIN GALLBLADDER
The most commonly recommended treatment for porcelain gallbladder, or any chronic gallbladder disease for that matter, is cholecystectomy. It is the surgical removal of the damaged organ. Complete cholecystectomy is said to be the most ideal course of action. However, for those whose tests for cancer turn up to be negative, an option for partial cholecystectomy is offered if the calcification is focalized.
The removal of the gallbladder, however, does not guarantee that the patient is free from cancer worries. Since there are cases wherein porcelain gallbladder patients develop gallbladder carcinoma, tests should be made to ensure that the surgery was executed early enough before the development of cancer cells or its spread to other nearby organs. This is because the thickening of gallbladder walls is the first sign of malignancy. For porcelain gallbladder patients who have been associated with gallbladder cancer, it is possible that a hepatectomy (removal of a part of the liver) may be performed in addition to cholecystectomy.
- Vitamin D3 and K3 Therapy
Since abnormal calcium metabolism may be one of the causes of porcelain gallbladder, supplementation of vitamins D3 and K2 should be considered for the prevention of gallbladder calcification. There is absolutely no research on the reversal of a porcelain gallbladder. However, since studies have demonstrated reversal of calcification of arteries, one could hypothesize that the principal is the same – using K2 to re-direct calcium to the right places. Prevention is one thing, reversal is another and if there is any chance that cancer is present, or even a possibility such as a non-complete calcification of the gallbladder, then experimenting with this would not be an option to even consider.
How Do Vitamin D3 and K2 Work with Calcium Metabolism
Vitamin D3 is vital in the regulation and absorption of calcium and phosphorous.It is also known to boost the immune system against numerous conditions such as cancer and diabetes. When taken on its own, one can already benefit from the vitamin. However, unknown to many, excessive vitamin D3 can be toxic if not partnered with K2. A symptom of Vitamin D toxicity is inappropriate calcification such as in porcelain gallbladder. According to Dr. Kate Rheaume-Bleue, a subject matter expert on the D3 and K2 partnership, the amount of vitamin D you should be taking depends on the amount of K2 you have. Unfortunately, 85% of people are vitamin K2 deficient.
There are three sets of vitamin K2-dependent proteins in the body – osteocalcin, matrix gla protein (MGP) and GAS6. The first one moves calcium around the body, MGP prevents calcium from going into arteries, ducts and all kinds of soft tissues, and GAS6 is effective for cancer protection. When vitamins D3 and K2 work together, they are beneficial for the maintenance of calcium levels and distribution throughout the body, and potentially preventing porcelain gallbladder.
Which Form of K2 is Best?
For optimal dosage, 200mcg of K2 is recommended for every 1,000 international units of Vitamin D taken. Since people with gallbladder problems have impaired fat metabolism, I recommend a liquid, emulsified form of D3/K2. For calcium metabolism problems, more K2 is called for than is generally found in the combination supplements. Order extra K2 in the form of MK-7 or menoquinione. MK-7 has a longer shelf-life in the body than the others do. K1 is not K2. You are looking for K2.