Gallbladder Pain (Gall Bladder Pain)

Gallbladder pain may vary or feel different depending on the cause.

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, commonly fatty foods. The pain may be described as intermittent, constant, abdominal, radiating to the back, or 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.

Biliary colic is a term used to describe the type of pain related to the gallbladder when the gallbladder contracts and the cystic duct is partially or completely blocked by a gallstone. The symptoms are described below.

Illustration of gallstones forming in the gallbladder

As stated previously, the major gallbladder problems that produce gallbladder pain are biliary colic, cholecystitis, gallstones, pancreatitis, and ascending cholangitis. Two major causes of pain 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.

Gallstone formation usually happens in the gallbladder but may form in any of the ducts. When the gallbladder is compressed (squeezed by musculature), bile usually goes out through the bile ducts into the GI tract; however, if gallstones or gallstone sludge is present, there can be partial or complete blockage of the ducts with pressure on the surrounding tissue, sometimes enough to cause local ischemia.

Other processes such as trauma can cause gallbladder pain. Infection of the biliary ducts and the gallbladder, usually occurring after gallstone obstruction also can cause pain.

Gallbladder pain may vary or feel different depending on the cause. Many people with gallstones never experience pain. However, some variations in gallbladder pain help the doctor to make a diagnosis.

• Biliary colic (intermittent duct blockage): Sudden and rapidly increasing pain (ache or pressure) in the right upper abdomen or epigastric area; some people will have pain radiating to the right shoulder (or back pain in the tip of the scapula) and/or also develop nausea and vomiting. The pain usually subsides in about 1 to 5 hours although a mild ache may persist for about a day.
• Cholecystitis (inflammation of the gallbladder tissue secondary to duct blockage): Severe steady pain in the upper-right abdomen that may radiate to the right shoulder or back, abdominal tenderness when touched or pressed, sweating, nausea, vomiting, fever, chills, and bloating; discomfort lasts longer than with biliary colic.
• Acalculous cholecystitis (no gallstones): Has similar symptoms to cholecystitis but occurs as a complication of other problems like trauma or burns; patients have severe symptoms and appear very ill.
• Pancreatitis: Gallstones from the gallbladder can block the pancreatic duct and cause pancreatitis (inflammation of the pancreas) with upper abdominal pain that may radiate to the back, tender abdomen, more pain after eating, nausea, and vomiting.
• Ascending cholangitis: (or simply cholangitis or infection of the biliary system) causes symptoms and signs that include fever, abdominal pain, jaundice, and even hypotension (low blood pressure), and confusion; it is a medical emergency.

The history and physical exam help to establish a presumptive diagnosis. Murphy's sign (pain or temporary respiratory arrest on deep right subcostal palpation) has been estimated to be over 95% specific for acute cholecystitis.

• A few laboratory blood tests such as liver function tests, lipase, amylase, complete blood count (CBC), and an abdominal X-ray are done to determine the exact problem that is causing the pain.
• Ultrasound can detect gallstones and thickening (due to inflammation) of the gallbladder wall, and CT scans may delineate organ structural changes. CT scans are not as effective as ultrasound for diagnosing gallstones but they provide more information than ultrasounds about other organs in the area.
• A HIDA scan (uses radioactive material) can measure gallbladder emptying while an ERCP test uses an endoscope to place a dye in the ducts of the pancreas, gallbladder, and liver.
• Magnetic resonance imaging (MRI) is sometimes used to detail the organ structures (liver, gallbladder, and pancreas); other tests also may be considered.

The results of these tests help pinpoint the problem and establish the diagnosis.

If you have no gallbladder pain (even if you have gallstones but never had pain), you need no treatment. Some patients who have had one or two gallstone attacks may elect to avoid treatment. Pain during an acute gallstone attack is often treated with morphine.

Medical treatments include:

• Oral bile salt therapy (<50% effective)
• Ursodiol (Actigall, for example)
• Dissolution
• Lithotripsy (shock waves)

The definitive treatment is gallbladder removal surgery (and/or the obstructing gallstones). Currently, the surgical method of choice is laparoscopic surgery, where the gallbladder is removed by instruments using only small incisions in the abdomen. However, some patients may require more extensive surgery. Usually, people do well once the gallbladder is removed unless there is an underlying cause that mimics gallbladder pain (for example, biliary dyskinesia, a motility disorder of the sphincter of Oddi).

Women who are pregnant are treated like women who are not pregnant, although pregnant women more commonly have cholesterol gallstone development than non-pregnant women. Although supportive care is tried in women who are pregnant, acute cholecystitis is the second most common surgical emergency in pregnancy (appendicitis is the first).

Home remedies include peppermint, alfalfa, apple cider vinegar, and others; you should check with your doctor before using these remedies.

Other home remedies for gallbladder pain relief include:

• Following a low-fat diet may reduce the frequency of biliary colic but has not been shown to dissolve gallstones.
• Coffee and regular exercise may reduce the incidence of gallstone disease and its associated gallbladder pain.
• Some healthcare professionals recommend decreasing dairy and grains in the diet after gallbladder removal; again, individuals should discuss such changes with their doctor.

The complications of gallbladder pain include:

• Discomfort with eating
• Poor food intake
• Weight loss
• Electrolyte abnormalities
• Consumption of pain medications
• Disruption of daily activities

Other complications of gallbladder disease include:

• Bile duct blockage
• Serious infections (empyema and gangrene of the gallbladder)
• Pancreatitis
• Peritonitis
• Infrequently, gallbladder cancer