My question concerns a 23-year-old friend who has a tendency to stretch the truth. She says she went to the emergency room for a gallbladder attack and that her gallbladder was so swollen by infection that doctors could not even tell if it had stones. Could the gallbladder really become infected almost overnight? If so, what could cause that to happen in such a young person?

T.K.

In a 23-year-old who is otherwise healthy, it is uncommon to have gallbladder disease at such a young age, but it is certainly possible. This is especially true if your friend was recently pregnant (pregnancy increases the risk of gallstone formation) or is overweight (people who are obese have much higher rates of gallstones).

The gallbladder is a small organ found near the liver that functions to store bile and digestive enzymes between meals. During meals, it releases its contents into the small intestine to aid in digestion. The main disease that occurs in gallbladders is the formation of stones, usually due to high levels of cholesterol in the bile. Although most people with gallstones experience no symptoms, some develop problems. The typical symptom of a gallbladder attack, or "biliary colic," is the sudden onset of severe pain in the upper right abdomen, often associated with nausea and vomiting. Patients who develop fever and chills may have an infectious complication in the gallbladder, which may require admission to the hospital for antibiotics and gallbladder removal.

When patients arrive at the hospital with symptoms suggesting a gallbladder attack, an ultrasound exam is usually conducted. It is unusual for the ultrasound to miss seeing stones if they are in the gallbladder. However, similar symptoms are experienced by patients who have gallbladder "sludge." Sludge is basically very small stones and gravel in the gallbladder. It may appear almost like a thick liquid on an ultrasound. Again, it is common for sludge to develop during pregnancy. This may explain why stones were not seen on your friend's ultrasound.

Finally, there is an entity known as "acalculous cholecystitis" in which the gallbladder becomes diseased in the absence of stones. This usually occurs in very ill patients who develop a poor blood flow to the gallbladder in conjunction with other severe medical problems. This disorder typically is seen in patients who are already in the hospital.