Yes, you can have gallbladder problems without having gallstones.

I suspect that you are experiencing pain in the right upper abdomen a few hours after eating, yet no gallstones were seen on an ultrasound examination. This situation tends to occur in younger women. The exact cause of pain cannot be determined.

The pain may be related to a motility problem (biliary dyskinesia), in which the gallbladder does not empty swiftly enough after a meal. Another proposed cause is malfunction of the sphincter of Oddi. This circular muscle lies at the entrance of the common bile duct into the duodenum (the first part of the small intestine). The sphincter of Oddi normally relaxes to allow bile to flow freely into the intestine. With inadequate relaxation, bile may back up and cause painful distention.

Several tests are available to try to prove that biliary dyskinesia plays a role in any given case. But it remains a somewhat murky area as the correlation of test results to symptoms is not that great. Many gastroenterologists believe that in many patients, the symptom falls into the "functional disorder" category, along with unexplained dyspepsia and irritable bowel syndrome. Perhaps there is an increased sensitivity to mild distention or contraction of the gallbladder, expressed as pain.

A different reason to account for typical biliary symptoms without visible gallstones is the presence of tiny crystals of cholesterol. You can think of these as very tiny gallstones too small to be seen on ultrasound. This diagnosis can be suggested by cloudy appearance on the gallbladder ultrasound, what doctors call "sludge." If necessary, the diagnosis of sludge can be confirmed by doing an endoscopy. The specialist can take a sample of fluid from the duodenum right where the bile duct enters. The sample is examined under the microscope to look for cholesterol crystals. If they are present, they are treated by removal of the gallbladder or with medication called ursodiol (Actigall) to dissolve the tiny stones.

Another unusual disease to consider is so-called "acalculous cholecystitis," an acutely inflamed gallbladder that does not contain any stones. It generally occurs in very sick patients suffering from burns or surgical complications, or those with underlying immunodeficiency disorders (advanced HIV infection). Usually, the gallbladder is very inflamed, distended and liable to perforate. Urgent surgery is needed to remove it.

A very rare cause of severe, persistent abdominal pain, usually with jaundice, is gallbladder cancer. An ultrasound or other imaging test such as CT scan would almost always show a major abnormality.