Gallbladder pain: Causes, symptoms, diagnosis, and treatment

What is gallbladder pain?

Gallbladder pain is a term used to describe pain originating from the structures in or around the gallbladder that affects its function. This may include conditions such as biliary colic, cholecystitis, gallstones, pancreatitis, and ascending cholangitis.

The gallbladder is a structure connected to the liver, which supplies it with bile—a yellowish-brown fluid that aids in the digestion of fats in the small intestine. Whenever we consume a fatty meal, the gallbladder contracts to excrete bile into the digestive tract. If a condition such as the ones mentioned above prevents the gallbladder from doing its job, it can lead to gallbladder pain.

Anatomy of the gallbladder

The gallbladder is a hollow structure located on the right side of the body, just under the liver. Its function is to store bile fluid received by the liver, serving as a reservoir for unused bile. When food is eaten, a hormone called cholecystokinin is released, which signals the gallbladder to contract and secrete bile via the common bile duct into the small intestine. Additionally, wastes produced by the liver can also be expelled this way.

The gallbladder wall is composed of an absorbent lining which further concentrates the stored bile. Having an excess of cholesterol, bilirubin, or bile salts can lead to the formation of gallbladder stones.

If small in size, a gallstone will not cause much of an issue. But if they reach a certain size, gallstones can obstruct the bile ducts, causing pain.

What causes gallbladder pain?

Gallstones

Also known as biliary calculi, these stones form due to imbalances in the level of cholesterol in the body. However, they may also form if the gallbladder does not empty efficiently.

Gallstones may range in size from one millimeter to several millimeters, and they usually do not cause any problems until big enough to block the bile ducts, which leads to pain. Symptoms of gallstones often present as severe abdominal pain, jaundice (yellowing of the skin and eyes), and fever.

There are several types of gallstones, and these may include:

Mixed stones: The most common type of gallstones, which are composed of cholesterol and bile salts.
Pigmented stones: Appearing greenish-brown in color, these stones are made up of bile pigments.
Cholesterol stones: Usually large and can block the flow of bile.

Cholecystitis

In most cases, inflammation of the gallbladder is caused by gallstones blocking the ducts that exit the gallbladder itself. Other potential causes of cholecystitis include bile duct problems and tumors leading to obstruction of bile flow.

Symptoms often present as severe pain in the right abdomen, pain in the right shoulder or back, nausea, vomiting, and fever.

Other Causes

The foods you eat are directly related to the development of gallbladder pain, creating a sort of sensitivity to particular food groups. These foods may include fatty meats, eggs, dairy products, and highly acidic fruits. Other pre-existing medical conditions, such as liver disease, may also trigger gallbladder pain.

Gallbladder pain symptoms

Biliary colic

Pain is often experienced as sudden and rapidly increasing in the upper-right abdomen, but it may also spread to other parts of the abdominal area. Biliary colic can occur at any time. It typically lasts anywhere from one to five hours but may last only a couple of minutes for some individuals.

The consumption of fatty food is a common trigger of biliary colic, and it is often accompanied by nausea and vomiting.

Acute cholecystitis

Inflammation of the gallbladder that develops over hours and usually due to a gallstone obstructing the cystic duct. Pain is generally severe and steady and lasts longer than biliary colic. The abdomen may feel tender to the touch or if pressed down and may be exacerbated by moving or coughing.

While a gallstone causing obstruction is the likely cause of this condition, acute cholecystitis can also be caused by complications of trauma known as acalculous cholecystitis.

Acute pancreatitis

A condition due to sudden inflammation of the pancreas, which is an organ involved in producing digestive enzymes. It is connected to the gallbladder via the common bile duct.

Acute pancreatitis can lead to severe abdominal pain that is typically felt below the ribs and can build up over days. Pancreatic pain can also be felt in the back and is associated with nausea and vomiting.

Cholangitis

Due to an infection of the bile duct and usually caused by bacteria that has ascended from the small intestine.
Common symptoms of this condition include right upper quadrant pain, fever, and jaundice. If mental status changes and signs of sepsis are observed, this is considered an emergency situation requiring immediate medical attention.

Other symptoms:

Acute abdominal pain
Pain that may travel to the back or between the shoulder blades
Pain that worsens after eating a meal, especially fatty meals
Increasing pain with deep breathing
Sweating
Weakness
Light-headedness
Shortness of breath
Dull, sharp, or crampy pain
Right upper quadrant pain of the abdomen
Chest pain
Heartburn, indigestion, and flatulence
Abdominal bloating
Nausea and vomiting
Fever with chills
Clay-like light colored stools
Jaundice

Risk factors for gallbladder pain

Women: Considered more likely to develop gallstones leading to gallbladder pain as pregnancy and hormone replacement (utilized by postmenopausal women) could lead to their increased development.
Certain medical conditions in children: Having a spinal cord injury, history of abdominal surgery, compromised immune system, and receiving IV nutrition has been seen to put children at risk for developing gallstones.

Certain nationalities: The Hispanic and Northern European populations are considered at greater risk of developing gallstones than Asian and African populations. Those living in North or South America, especially the native women population in Chile and Peru, are thought to be especially vulnerable to develop gallstones.

Family history: It has been shown that heredity plays a role in gallstone development.

Metabolic disorders: Those who suffer from diabetes and obesity have a high risk of developing gallstones and therefore gallbladder pain.

Other risk factors: Crohn’s disease, bone marrow or solid organ transplant, chronic hemolytic anemia, sickle cell anemia, consuming high amounts of iron, cirrhosis, and metabolic syndrome.

How to diagnose gallbladder pain?

Abdominal ultrasound: The use of high-frequency sound waves that can bounce off structures within the abdomen and represent as an image on-screen. This test is non-invasive and can be done in the office. An ultrasound is an excellent test for gallstones.
HIDA scan (cholescintigraphy): A radioactive dye is injected into the person, which is then secreted into the bile by the body. At this point, a scan is done on the gallbladder to see if bile is moving as it should throughout the bile system.
Cholangiography: Done by injecting dye into the bloodstream, and then allowing it to concentrate in the gallbladder and bile duct. An x-ray is then taken showing the various structures and any signs of obstruction.
Endoscopic retrograde cholangiopancreatography (ERCP): Uses a dye that is directly injected into the bile duct system via the small intestine to access the bile ducts. The test can be used to diagnose any cause of obstruction but can also be used to treat some gallstone conditions.
Magnetic resonance cholangiopancreatography (MRCP): Used to visualize the biliary and pancreatic ducts in a non-invasive manner, MRCP uses the help of magnetic resonance imaging to determine if gallstones are blocking the ducts surrounding the gallbladder.
Endoscopic ultrasound: Similar to a regular ultrasound except that it is performed from within the body. A flexible tube with a tiny ultrasound probe on the end of it is inserted into the mouth down to the intestines. High-frequency sound waves are then used to produce an image of the biliary structures.
Abdominal X-ray: Useful only for detecting gallstones that are dense and composed of a material that can be picked up through this method of imagining.

How to treat gallbladder pain

Your ideal treatment may vary depending on the underlying cause of your gallbladder pain. Also, depending on the frequency and severity of pain symptoms, some medical interventions will be chosen over others. The following are some of the most commonly implemented treatment options used in patients suffering from gallbladder pain.

Cholecystectomy: Commonly known as gallbladder surgery or the removal of the gallbladder, it is the most effective treatment for gallbladder pain. The surgery can be open or via laparoscopy. The latter is preferred due to it being less invasive and involves only making a small incision as opposed to making a large one in open surgery.
Antibiotics: If an infection is causing gallbladder pain, using antibiotics can help relieve it and prevent the spread.
Painkillers: This may include Demerol or Toradol. NSAIDs such as ketorolac are not used if the patient may require surgery. Opioid medications such as morphine may be utilized but are generally avoided due to their addictive potential.
Chemotherapy and radiotherapy: If gallbladder pain is due to cancer, both therapies can be used to prevent cancer from returning.
Ursodeoxycholic acid: An oral drug option for those who are not good candidates for surgery. It helps to dissolve small cholesterol gallstones and reduce symptoms of gallbladder pain.
Extracorporeal shock-wave lithotripsy: The use of high-energy shock waves via a device that projects them through the abdominal wall. This therapy helps to break down gallstones but works best when only small stones are present.
Contact solvent dissolution: A rare technique using chemicals that are directly injected into the gallbladder to aid in dissolving them.

Home Remedies for Gallbladder Pain

When experiencing intense abdominal pain, it is a good idea to seek medical attention as soon as possible to make sure it isn’t due to a life-threatening complication. However, know that if you suffer from relatively benign gallbladder pain, you may try some home remedies to help ease the pain. These include:

Exercise: Regular exercise can help reduce cholesterol levels, and because cholesterol plays a role in the formation of gallstones, it’s important to keep levels low. Furthermore, regular exercise can help with weight management and being overweight is linked with greater gallbladder pain attacks.
Dietary changes: You want to avoid foods high in fat and sugar as these foods can worsen gallbladder pain and stones. Upping your fiber is also important to improve overall health. Some key foods to consume are dark leafy greens, nuts, olive oil, fish, brown rice, whole grains, citrus fruits, and low-fat dairy.
Heated compress: Using a heated compress over the area of the gallbladder can help alleviate pain caused by spasms along with relieving the pressure of built-up bile.
Peppermint tea: Peppermint contains menthol which is soothing and can aid in pain relief. It is often used to ease stomach irritation along with nausea. Drinking it regularly may help reduce the number of gallstone attacks you experience.
Apple cider vinegar: Raw apple cider vinegar has anti-inflammatory properties which may aid in relieving pain. Dilute a couple of tablespoons of apple cider vinegar in water and consume regularly
Drink at least 8 cups (1.9 L) of water per day: Water helps break down substances in the body and can help flush out toxins and waste from the body. Your activity level this will determine if you require more water.
Avoid skipping meals or crash dieting: Eating regularly is important because dieting and skipping means makes the body release extra cholesterol from the liver and turn it into bile, which contributes to gallstones.

If you experience symptoms despite all your efforts, going to the emergency room is a wise choice. If you choose not to seek professional care, you may experience the eventual complications of gallbladder pain. These include discomfort while eating, weight loss, electrolyte abnormalities, and a decrease in quality of life.