Doctor's Notes on Gallbladder Pain
Gallbladder pain is a symptom or sign of problems in the biliary tract. Gallbladder pain is also termed biliary colic. Symptoms and signs include severe pain and nausea with or without vomiting; the pain frequency is usually intermittent. The pain may fluctuate in intensity and may last about 15 minutes to several hours and is maximal in the mid-upper abdomen or right upper abdomen. Moving does not make the pain worse. The pain may radiate to other areas such as the right shoulder or to the tip of the right scapula. Other signs and symptoms related to gallbladder pain are sweating, lightheadedness and shortness of breath.
The cause of gallbladder pain is usually either gallstones or cholecystitis. Gallstones may form in the gallbladder and may have a tendency to become lodged in the bile ducts. This can block normal bile flow and cause the ducts and/or the gallbladder tissue to stretch causing moderate to severe pain. Release of pressure reduces or stops the pain. Cholecystitis (inflammation of the gallbladder) can cause bile flow reduction and/or stoppage. Other less frequent causes of bile blockage can occur like bleeding into the bile ducts or tumors pressing on the ducts.
Gallbladder Pain Symptoms
Other non-specific symptoms, more likely caused as a response to pain rather than the obstruction, are:
- sweating (diaphoresis),
- light-headedness, and
- shortness of breath.
Symptoms that suggest other causes for pain are pain that is maximal in the lower abdomen, abdominal bloating or belching, and abnormal bowel patterns.
Gallbladder Pain Causes
The pain of gallbladder disease almost always has one of two causes - gallstones or cholecystitis. Gallstones are stones that form in the gallbladder (often misspelled "gall bladder"). They vary in size from a millimeter or two to several centimeters and are made up of cholesterol or bile pigments. Cholecystitis means inflammation of the gallbladder. Although, cholecystitis is most commonly caused by gallstones, there are other less common causes as well.
What is the mechanism of gallbladder pain?
Gallstones have a tendency to become lodged in the bile ducts leading from the gallbladder or liver into the intestines. When gallstones lodge in the ducts, they give rise to a specific type of pain called biliary colic. The characteristics of biliary colic are very consistent, and it is important to recognize its characteristics because they direct the physician to the most appropriate test to diagnose gallstones, primarily abdominal ultrasonography. In approximately 5% of cases, ultrasonography will fail to show gallstones. In such situations, if the characteristics of biliary colic are typical, physicians will go on to other more advanced tests for diagnosing gallstones, specifically endoscopic ultrasound. Finally, most gallstones do not cause pain, and are frequently found incidentally during abdominal ultrasonography. If the symptoms for which the ultrasonography is being done are not typical of biliary colic, it is unlikely that the symptoms are caused by gallstones. The gallstones can be truly silent. This is important to recognize because surgery to remove the gallstones is unlikely to relieve the symptoms.
When gallstones lodge suddenly in the duct leading from the gallbladder (cystic duct), the duct leading from the liver to the cystic duct (common hepatic duct), or the duct leading from the cystic duct to the intestine (common bile duct), the normal flow of bile from the liver is interrupted. With obstruction of the common hepatic or common bile duct, the backup of bile causes the ducts (and the gallbladder in the latter case) to distend. This distention (stretching) is the cause of the biliary colic. When obstruction of the cystic duct occurs, fluid is secreted into the gallbladder causing it to distend. Again, the distention causes biliary colic. Biliary colic stops when the gallstone unlodges from the duct.
The sudden obstruction of the bile ducts causes biliary colic. Other processes that suddenly obstruct the ducts also can cause biliary colic, for example, bleeding into the ducts or the entry of parasites into the ducts, but these causes are rare. The occurrence of slowly progressive obstruction does not cause biliary colic unless sudden obstruction is superimposed upon the progressive obstruction. For this reason, it is uncommon for slowly growing cancers of the bile ducts, gallbladder, or pancreas (through which the common bile duct passes) to cause biliary colic.
Diagnosis of gallstones as cause of biliary pain In addition to ultrasonography, it may be useful to obtain blood tests to assess the liver function (aminotransferases) and pancreas (amylase). If the tests are abnormal they support the diagnosis of a process involving the liver, bile ducts and gallbladder, or pancreas. They do not indicate specifically what the problem is, but an early rise and rapid fall in their levels suggests obstruction of the biliary ducts. Endoscopic ultrasonography is the best test for diagnosing gallstones, but it is expensive and carries the risk of complications.
The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas. Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. The pain is often nonspecific and can be caused by a variety of conditions.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.