**Core Concept**
The gallbladder plays a crucial role in the digestion of fats by storing and concentrating bile. In the context of extreme starvation, the body's physiological response is aimed at conserving energy and maintaining vital functions.

**Why the Correct Answer is Right**
In extreme starvation, the gallbladder's response is to contract less frequently, leading to a decrease in bile release. This decrease in gallbladder contraction is due to the reduced stimulation by **cholecystokinin (CCK)**, a hormone released in response to food intake, especially fats. As a result, the gallbladder becomes distended with concentrated bile.

**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because the gallbladder does not increase its contraction frequency during starvation.
**Option B:** Incorrect as the gallbladder's response is not to become smaller in size due to muscle atrophy during the initial phases of starvation.
**Option C:** Incorrect because while the gallbladder does concentrate bile, the primary response in extreme starvation is related to its contraction frequency.

**Clinical Pearl / High-Yield Fact**
A key point to remember is that during starvation, the body adapts by reducing non-essential functions, including digestive processes. Understanding these adaptations is crucial for managing patients undergoing prolonged fasting or starvation.

**Correct Answer:** D. Gallbladder becomes distended with concentrated bile.