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Gallbladder pain due to disease related to the gallbladder. The major gallbladder problems that produce gallbladder pain are biliarycolic, 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.
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.
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.
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.
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).
Home remedies include peppermint, alfalfa, apple cider vinegar, and others; you should check with your doctor before using these remedies.
Complications of gallbladder pain
The complications of gallbladder pain include discomfort with eating, poor food intake, weight loss, electrolyte abnormalities, consumption of pain medications, and disruption of daily activities. However, complications of gallbladder disease include bile duct blockage, serious infections (empyema and gangrene of the gallbladder), pancreatitis, peritonitis, and infrequently, cancer.
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Gallbladder Pain: Symptoms and Treatments
Gallbladder pain is a common occurrence in the right upper abdomen, just below the ribs. It can also be felt in the upper middle section of the abdomen. Although it is sometimes referred to as biliary colic, it is not an intermittent pain. Alternatively, it is generally a steady pain that can be described as gnawing or gripping, which can vary from mild to severe. It can last from a few minutes to several hours, depending on the cause. If it persists for longer, it may be associated with a more serious underlying cause.
Another characteristic of gallbladder pain is that it may radiate to the upper portion of the back; changing your position does not relieve the pain. Painful episodes may be triggered by a fatty meal, though it may not surface for several hours after eating and may awaken you in the middle of the night. It may return at the same time daily, although it could be a less frequent reoccurring condition.
Other symptoms may also be associated with gallbladder pain, such as:
- Nausea and vomiting
- Yellowing of the eyes and skin
- Severe abdominal pain
- Feeling of fullness
- Diarrhea or constipation
- Fatty stools
- Burping with regurgitation of bitter fluid
- Shortness of breath
Gallbladder pain may be caused either by gallstones or inflammation of the gallbladder (cholecystitis).
Although most gallstones do not cause pain, a few people experience gallbladder pain several years after they form. They usually cause a mild to severe pain in the right upper abdomen or middle section behind the breastbone, and this pain rapidly intensifies in a few minutes to hours. The pain radiates to the right shoulder and upper back. It is caused by the obstruction of the bile ducts by the gallstones, which pass from the gallbladder or liver to the small intestine.
The most common cause of gallstone formation is too much cholesterol in the diet that cannot be handled by the bile from the liver. When cholesterol accumulates, it can form cholesterol gallstones and these can block the bile ducts leading to the intestine, causing the associated pain. The pain may disappear when the stone is dislodged.
There are several risk factors linked to gallstone formation, including:
- Gender – females are more likely to be affected
- Age – older people, 60 years and above are at risk
- Race – more common among American Indians and Mexican-Americans
- High-fat, low fiber diet
- High blood cholesterol
- History of gallstones in the family
- Medications – cholesterol lowering drugs, estrogen therapy
- Rapid weight loss
This condition is characterized by inflammation of the gallbladder. It may be related to the presence of a gallstone (calculous cholecystitis) or may be due to other obstructions not associated with gallstones (acalculous cholecystitis).
About 1-3% of people who have gallstones may experience acute gallbladder inflammation or acute cholecystitis, and the symptoms are more severe and persistent. The pain may be experienced when jumping (jarring motion) or even when inhaling. Patients usually want to lie still and may experience fever, chills, nausea, and vomiting.
People who experience these should seek immediate medical attention as complications including infection may occur. Diabetics are at higher risk of developing this disease.
In some, these symptoms are mild and vague, and are therefore difficult to differentiate from similar symptoms associated with other gastrointestinal disorders. You may experience abdominal discomfort (especially after eating), nausea, gas, and chronic diarrhea. These are caused by chronic cholecystitis, in which the gallbladder becomes stiff due to scarring.
Other Possible Causes
Uncommon causes of gallbladder pain include blockage of the common bile duct (choledocholithiasis), which in addition to severe pain, can cause yellowish skin and eyes, dark colored urine, light colored stools, and rapid heartbeats with a drop in blood pressure.
Other causes of gallbladder pain include bleeding inside the bile ducts, entry of parasites such as worms into these passages, and cancers of the gallbladder, bile ducts or pancreas.
Pain related to heart attacks may be mistaken for gallbladder pain, which may be felt as a upper-mid abdominal pain and may be accompanied by nausea and vomiting. This is of particular concern for those who are at risk of a heart attack.
Imaging examinations (ultrasound, Ct scan, etc ) and blood tests will be used to diagnose a gallbladder disorder.
Avoiding the risk factors associated with gallbladder disease, such as high fat, low fiber diet, may help prevent stone formation and gall bladder inflammation. Those who are diagnosed with gallstones but do not experience symptoms may not require treatment beyond diet modification.
However, for those diagnosed with gallstones or cholecystitis who experience symptoms, the most definitive treatment is surgical removal of the stones and the diseased gallbladder.
Although some doctors may prescribe medications to dissolve the gallstones, they may take a long time to treat. Furthermore, gallstones may recur in most patients. Patients with small gallstones that are made up of cholesterol may benefit more from drug treatment rather than obese people with calcified stones.
The use of antibiotics and pain killers alone are not effective in relieving gallbladder pain due to gallstones or cholecystitis. These treatments are therefore inappropriate for treating these disorders since recurrence rates are high and complications may occur. There are no home remedies or alternative treatments for gallbladder disease. If you have these symptoms, consult a doctor for proper treatment.
Abdominal Pain During Pregnancy
Lower Abdominal Pain
Many women experience lower abdominal pain during the early weeks of pregnancy. There are many reasons for this. For some women occasional or sporadic abdominal discomfort during pregnancy similar to menstrual cramps may simply be a sign that your uterus is preparing to carry your baby through the next nine months of pregnancy.
Many women will experience occasional bouts of Lower abdominal pain during pregnancy. While frightening at best abdominal pain during pregnancy is usually a normal and harmless condition. Lower abdominal pain during pregnancy can sometimes suggest a more serious problem however, so it is important you consult with your health care provider if you have any concerns regarding abdominal pain during pregnancy.
Abdominal pain that comes on suddenly, persistent, and severe, and associated with other problems such as nausea, vomiting, vaginal bleeding, or contractions suggests the pain is not due to normal pregnancy changes but some other problem.
Normal Changes in Pregnancy that Cause Abdominal Pain
The Enlarging uterus as it raises out of the pelvis places pressures on the lower back and abdomen and produces pain. The enlarged uterus may also compress the ureter, (the tube between the bladder and the kidney) making it difficult for urine to pass down the ureter causing intermittent severe lower abdominal pain. This pain can mimic the pain associated with passing a kidney stone, or bladder infection.
In addition, the Hormonal changes during pregnancy can decrease lower esophageal sphincter tone (esophageal reflux) causing symptoms of indigestion and dyspepsia.
Pregnancy Health Section
Pregnancy Related Causes of Abdominal Pain
Non-Pregnancy Related Causes of Lower Abdominal Pain
- Acute appendicitis — Appendicitis is the most common cause of right quadrant, lower abdominal pain that requires surgery during pregnancy. The most symptom of appendicitis, is low grade fever and right lower quadrant pain.
The good news is most women will experience mild abdominal discomfort throughout their pregnancy that occasionally occurs from the uterus stretching, from gas or even from constipation.
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Who’s at risk for gallbladder pain?
The following groups of individuals are most likely to experience some form of gallbladder problem or disease:
Avoiding gallbladder pain
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The Gallbladder’s main function is to store bile that is generated by the Liver. The bile then goes to work by breaking down and digesting fatty foods. The gallbladder and the liver also work together in managing cholesterol and are assisted by Lecithin. Lecithin is a “Fat” which is essential in the cells of the body. Lecithin can be found in many foods, including soybeans. It is used for many things and that includes keeping the gallbladder and liver from disease. If the gallbladder gets diseased it can be removed as it is not essential. There would be no health risks in a healthy individual, however, there could be a small risk of diarrhea and fat Malabsorption.
Abstract… The gallbladder epithelium has the capacity to absorb cholesterol and provides a cholecystohepatic shunt pathway for bile acids….
Abstract. …One of the most important risk factors is female gender. Rates of gallstones are two to three times higher among women than men.
Abstract. Estrogen increases biliary cholesterol secretion causing cholesterol supersaturation of bile. Thus, hormone replacement therapy in postmenopausal women and oral contraceptives has also been described to be associated with an increased risk for gallstone disease.
Abstract. Five experimental groups were studied: 29 patients with uncomplicated gallstones before and 1 month after elective cholecystectomy, 22 patients 4 years after elective cholecystectomy, 14 patients with postcholecystectomy diarrhea, 5 patients with acute infectious diarrhea, disease controls, and 13 patients before and 1 month after other elective surgery, surgical controls.
Abstract. Here, we demonstrate that consumption of a high-fat, HF, diet impairs the central actions of insulin……We conclude that consumption of a HF diet leads to central insulin resistance following short exposure to the diet, and as demonstrated by reductions in insulin signaling and insulin-induced hypothalamic expression of POMC mRNA.
The feedback mechanism by which cholesterol synthesis is regulated in liver has been studied. Evidence has been presented which indicates that exogenous cholesterol inhibits cholesterol synthesis primarily by blocking the conversion of β-hydroxy-β-methylglutaryl CoA to mevalonic acid. This reaction would appear to represent the major biochemical site of normal homeostatic control of cholesterol synthesis in the liver.
Lecithin…. It is also used for treating gallbladder disease, liver disease, certain types of depression, high cholesterol, anxiety, and a skin disease called eczema.
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