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What is gallbladder pain?
Gallbladder pain is (often misspelled "gall bladder") an all-inclusive term used to describe any pain due to disease related to the gallbladder. The major gallbladder problems that produce gallbladder pain are biliary colic, cholecystitis, gallstones, pancreatitis, and ascending cholangitis. Symptoms vary and may be triggered by eating certain foods. The pain may be described as intermittent, constant, abdominal, radiating to the back, mild to severe depending on the underlying cause.
A brief review of the gallbladder anatomy and function may help readers better understand gallbladder pain. The gallbladder is connected to the liver via ducts that supply bile to the gallbladder for storage. These bile ducts then form the common hepatic duct that joins with the cystic duct from the gallbladder to form the common bile duct that empties into the GI tract (duodenum). In addition, the pancreatic duct usually merges with the common bile duct just before it enters the duodenum. Hormones trigger the gallbladder to release bile when fat and amino acids reach the duodenum after eating a meal (see illustration below), which facilitates the digestion of these foods. Statistics suggest that women may have up to twice the incidence of gallstones than men.
As stated previously, the major gallbladder problems that produce gallbladder pain are biliary colic, cholecystitis, gallstones, pancreatitis, and ascending cholangitis. There are two major causes of pain that either originate from the gallbladder or involve the gallbladder directly. They are due to 1) intermittent or complete blockage of any of the ducts by gallstones; or 2) gallstone sludge and/or inflammation that may accompany irritation or infection of the surrounding tissues, when partial or complete obstruction of ducts causes pressure and ischemia (inadequate blood supply due to a blockage of blood vessels in the area) to develop in the adjacent tissues.
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.
The most common symptom that accompanies biliary colic is nausea with or without vomiting. The vomiting does not make the pain better since it has no effect on the distended ducts or gallbladder.
Other non-specific symptoms, more likely caused as a response to pain rather than the obstruction, are:
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.
Other Causes of Biliary Pain
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.
Gallbladder pain may vary or feel different depending on the cause. Many people with gallstones never experience pain. However, there are some variations in gallbladder pain that help the doctor to make a diagnosis.
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