Disease: Gallbladder Pain (Gall Bladder Pain)

    Gallbladder pain definition

    Gallbladder pain is 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.

    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.

    What are the causes of gallbladder pain?

    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.

    Gallstones usually form 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 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.

    Illustration of Gallstones Forming in the Gallbladder

    What is biliary colic?

    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.

    What are the symptoms associated with gallbladder pain?

    Gallbladder pain may vary; many people with gallstones never experience pain. However, there are some variations in gallbladder pain that 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 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 gallbladder tissue secondary to duct blockage): severe steady pain in the right upper 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, with nausea and vomiting.
    • Ascending cholangitis (or simply cholangitis or infection of the biliary system) causes fever, abdominal pain, jaundice and even hypotension (low blood pressure), and confusion; it is a medical emergency.

    How is the cause of gallbladder pain diagnosed?

    The history and physical exam helps 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 tests such as liver function tests, lipase, amylase, complete blood count (CBC), and an abdominal X-ray are done to determine the exact problem is causing the pain. Ultrasound can detect gallstones, and CT scan may delineate organ structural changes. A HIDA scan (uses radioactive material) can measure gallbladder emptying while an ERCP test uses an endoscope to place 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). The results of these tests help pinpoint the problem and establish the diagnosis.

    What is the treatment of gallbladder pain?

    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 attacks may elect to avoid treatment. Pain during an acute attack is often treated with morphine. The definitive treatment is to remove the gallbladder (and/or the obstructing gallstones) by surgery. 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.

    Women who are pregnant are treated like women who are not pregnant, although pregnancy is a risk factor for cholesterol gallstone development. 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).

    What are the causes of gallbladder pain?

    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.

    Gallstones usually form 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 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.

    Illustration of Gallstones Forming in the Gallbladder

    What is biliary colic?

    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.

    What are the symptoms associated with gallbladder pain?

    Gallbladder pain may vary; many people with gallstones never experience pain. However, there are some variations in gallbladder pain that 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 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 gallbladder tissue secondary to duct blockage): severe steady pain in the right upper 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, with nausea and vomiting.
    • Ascending cholangitis (or simply cholangitis or infection of the biliary system) causes fever, abdominal pain, jaundice and even hypotension (low blood pressure), and confusion; it is a medical emergency.

    How is the cause of gallbladder pain diagnosed?

    The history and physical exam helps 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 tests such as liver function tests, lipase, amylase, complete blood count (CBC), and an abdominal X-ray are done to determine the exact problem is causing the pain. Ultrasound can detect gallstones, and CT scan may delineate organ structural changes. A HIDA scan (uses radioactive material) can measure gallbladder emptying while an ERCP test uses an endoscope to place 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). The results of these tests help pinpoint the problem and establish the diagnosis.

    What is the treatment of gallbladder pain?

    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 attacks may elect to avoid treatment. Pain during an acute attack is often treated with morphine. The definitive treatment is to remove the gallbladder (and/or the obstructing gallstones) by surgery. 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.

    Women who are pregnant are treated like women who are not pregnant, although pregnancy is a risk factor for cholesterol gallstone development. 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).

    Source: http://www.rxlist.com

    The history and physical exam helps 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 tests such as liver function tests, lipase, amylase, complete blood count (CBC), and an abdominal X-ray are done to determine the exact problem is causing the pain. Ultrasound can detect gallstones, and CT scan may delineate organ structural changes. A HIDA scan (uses radioactive material) can measure gallbladder emptying while an ERCP test uses an endoscope to place 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). The results of these tests help pinpoint the problem and establish the diagnosis.

    Source: http://www.rxlist.com

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