The Association between Strawberry Gallbladder and Cholesterol

Strawberry gallbladder, commonly known as cholesterolosis and lipoidosis, is a proliferative and degenerative disease most commonly found in females in the fourth and fifth decade of life. This is usually asymptomatic but sometimes may exhibit mild symptoms such as indigestion, gas and distress after meals. Pain in the upper quadrant is also noted.

The tissues of the gallbladder are composed of mucosa, lamina propria, muscle layer and connective tissues. Cholesterolosis occurs when there is an abnormal deposit of cholesterol in the lamina propria and mucosa. The deposits in the gall bladder may appear to be patchy or diffuse. Most commonly, it is in diffused form appearing as a bright red mucosa with yellow dots or mottling. The mottling is due to the lipids or cholesterol that attach in the gallbladder wall. When seen macroscopically, it looks like a ripened strawberry, which is why cholosterolosis is termed as strawberry gallbladder. In the patchy localised form, cholesterolosis may appear to be multiple, very small polyps attached from non-inpendent wall of the gallbladder. The polyps may differ in size, varying from 1-10 mm, and are not visible in radiography.

Cholesterol, along with phospholipids, electrolytes and water, is used by the liver to form bile. The bile is one of the major products that digest dietary fats. The bile is then stored in the gallbladder. The gallbladder also concentrates the bile by removing water and electrolytes. When the small intestines signal the presence of dietary fat, it secretes the bile for fat emulsification. Since cholesterol is not soluble in water, excessive cholesterol in the bile may cause the cholesterol to fall out of solution. The excess cholesterol is then the cause of many diseases in the gallbladder, such as strawberry galbladder. 

Strawberry gallbladder is diagnosed in different ways. one of which is by using cholecystography. In cholecystography, the gallbladder is visualized by x-ray after swallowing a contrast dye. The contrast dye makes the gallbladder appear to be opaque in the cholecystogram x-ray film. Another diagnostic procedure is ultrasonography. The ultrasound imaging of strawberry gallbladder is very definitive in appearance. The polyps can be visualised as echogenic non-mobile masses. Urine and blood tests can also be used to determine the high cholesterol level in the body, but do not necessarily diagnose gallbladder diseases, for they are only physical results that need further evaluation.

Even symptoms are not directly suggestive of any gallbladder disease; doctors have many ways to visualise and diagnose those diseases. With these tests, gallbladder diseases such as strawberry gallbladder can be diagnosed effectively and treated promptly.