What Does Gallbladder Pain Feel Like: Location, Duration, and More

Gallbladder pain can be sudden, intense, and severe.

The most common reason for the pain is gallstones — hardened deposits of digestive fluid that can form inside your gallbladder. Inflammation or infection of your gallbladder are other possible culprits.

The good news is there are treatments to effectively relieve gallbladder pain.

Read on to learn more about what gallbladder pain feels like and how to alleviate the discomfort.

Your gallbladder is a small sac that’s located in your right upper abdomen, just below your liver. According to the Canadian Society for Intestinal Research, your gallbladder stores bile — a digestive fluid — that’s made by your liver.

Gallstone pain

Bile helps break down fats during digestion and is made up of different substances, such as:

• cholesterol
• salts
• water

Your liver continually makes bile until you consume food. When you eat, your stomach releases a hormone that causes muscles around your gallbladder to release the bile.

Gallbladder pain is an indication that something isn’t right.

When gallstones cause a blockage of one of the ducts that move bile, they can trigger sudden and escalating pain, which is sometimes dubbed a “gallstone attack.”

Pain location

The pain is usually felt in your upper right abdomen but can spread to your upper back or shoulder blade.

Some people also experience pain in the center of their abdomen, just below their breastbone. This discomfort can last several minutes to a few hours.

A 2012 research review showed that up to 15 percent of adults in the United States have or will have gallstones.

Gallstones don’t always lead to pain. According to the Canadian Society of Intestinal Research, studies show that about 50 percent of patients with gallstones don’t experience symptoms.

Gallbladder inflammation pain

Inflammation of your gallbladder, a condition called cholecystitis, commonly happens when gallstones block the tube leading out of your gallbladder. This produces bile buildup, which can cause inflammation.

Other conditions can also trigger inflammation of your gallbladder, including:

• tumors
• serious illnesses
• bile duct problems
• certain infections

Symptoms of cholecystitis may include:

• severe pain in your upper right abdomen or center of your abdomen
• pain that spreads to your right shoulder or back
• tenderness above your abdomen
• nausea or vomiting
• fever

These symptoms often happen after eating, especially following a large or fatty meal. If untreated, cholecystitis can lead to serious, even life threatening complications, such as:

• a gallbladder rupture (where your gallbladder wall leaks or bursts)
• infection
• gangrene (when tissue in your gallbladder dies)

Gallbladder infection pain

A gallbladder infection is another condition that can occur when a gallstone causes an obstruction. When the bile builds up, it can become infected and lead to a rupture or abscess.

Symptoms of a gallbladder infection may include:

• abdominal pain
• fever
• trouble breathing
• confusion

According to Johns Hopkins Medicine and the Canadian Society of Intestinal Research, if you’re having a gallstone attack, you may also experience other symptoms, such as:

• nausea or vomiting
• tenderness in the area surrounding your gallbladder
• low-grade fever
• light-colored stool
• brownish-colored urine
• yellowing or discoloration of your skin or whites of your eyes

According to the National Organization for Rare Disorders, other conditions may cause symptoms that feel similar to gallbladder pain. Some of these include:

• Gallbladder cancer. Gallbladder cancer can cause abdominal pain, itching, bloating, and fever. Imaging tests may help your doctor determine if the pain you feel is due to cancer or gallstones.
• Appendicitis. Appendicitis typically causes pain in the lower right side of your abdomen, while you can usually feel gallbladder pain in the upper to the mid-right area, towards your back.
• Heart attack. According to Johns Hopkins Medicine, sometimes, people mistake gallbladder pain for symptoms of a heart attack. Other heart attack symptoms include shortness of breath, chest pain, weakness, and jaw, neck, or back pain.
• Pancreatitis. Pancreatitis is inflammation of your pancreas. This condition may cause pain that feels similar to a gallbladder attack. But with pancreatitis, you may also experience other symptoms, such as weight loss, a fast heart rate, and oily or foul-smelling stools, according to the University of Iowa.
• Ulcers. Sometimes, ulcers can cause abdominal pain, but they can also trigger burning stomach pain, bloating, a fullness feeling, burping, heartburn, and other symptoms.
• Inflammatory bowel diseases. Certain bowel diseases may mimic signs of gallbladder pain, but they also cause diarrhea, bloody stool, and weight loss.
• Gastroenteritis. Also known as the “stomach flu,” gastroenteritis may be mistaken for a gallbladder issue. Symptoms such as nausea, vomiting, watery diarrhea, and cramping are hallmarks of the stomach flu.
• Kidney stones. Kidney stones can cause sharp pains in your abdomen, side, and back. You might also have pink, red, or brown urine, foul-smelling urine, cloudy urine, or a constant need to urinate.

You should call your doctor if you have any symptoms of gallbladder pain that concern you.

Certain complications of a gallstone attack can be serious or life threatening. You should seek immediate medical care if you develop:

• severe abdominal pain
• yellowing or discoloration of your skin or whites of your eyes
• a high fever with chills

Doctors may perform different tests to diagnose your condition, including an:

• ultrasound
• blood test
• another type of imaging test

According to Johns Hopkins Medicine, there’s not much you can do to stop a gallbladder attack while it’s happening.

You may want to apply a heated compress to the area to relieve the discomfort. Usually, the pain will ease once the gallstone has passed.

Traditional treatment options for gallbladder attack include surgery to remove your gallbladder or medicines to help dissolve the gallstones.

You might be able to prevent a gallstone attack by reducing your fatty food intake and maintaining a healthy weight.

Some other measures that could lower your chances of having gallbladder pain include:

• Eating on a schedule. Skipping meals or fasting may increase the risk of gallstones.
• Eat more fiber. Foods like veggies, fruits, and whole grains contain lots of fiber.
• Try to lose weight slowly. If you lose weight too quickly, you’re at an increased risk for developing gallstones. Aim for 1 to 2 pounds a week.
• Exercise. According to the Canadian Society for Intestinal Research, studies show that regular physical activity can lessen your chances of gallstones.
• Check your meds. Some medicines, such as postmenopausal hormones, may boost the risk of gallbladder disease.
• Try magnesium. Studies suggest that males who consume the most magnesium have a lower risk of developing gallstone disease.

Gallbladder pain is usually caused by gallstones that block bile ducts. This common condition can cause severe pain.

For some people, the discomfort will go away on its own. Others may need treatments or surgery to remove their gallbladder. You can function well and live a full life without a gallbladder.

Picture, Function, Diseases, Tests, and Treatments

Gallbladder Image
Functions of the gallbladder
Gallbladder Diseases
Gallbladder Tests
Gallbladder Treatments
Gall bladder medicines

Gallbladder Image

The gallbladder is an organ that looks like an elongated pear and can hold anywhere between 30 and 50 millilitres of fluid. Because of its muscular contractions, it not only stores the bile but also concentrates it, and then it releases the bile into the duodenum.

Bile juice is beneficial for the digestion of lipids. It not only includes bile salts but also bile pigments, such as biliverdin and bilirubin. In some cases, the gallbladder must be removed, however, this does not change or improve the situation.Radio opaque substances, which are passed out of the body in the bile, are also concentrated in the bile. So, they are used in the process of cholecystography, which uses x-rays to show the gallbladder’s cavity as well as its ability to contract and concentrate.

Functions of the gallbladder

The main functions of the gallbladder are:

• Storage of bile: The gallbladder stores and concentrates bile produced by the liver, which helps the body digest fats easily.
• Gallbladder releases bile: When we eat, especially a meal high in fats, the gallbladder releases bile into the small intestine to emulsify the fats, making them easier to absorb by the body.
• Regulating bile flow: The gallbladder regulates the flow of bile into the small intestine by contracting or relaxing its muscles, to release bile in a controlled manner.
• Bile pH regulation: The gallbladder also plays a role in regulating the pH of bile. Bile can become too acidic, which may cause the formation of gallstones.
• Absorption of certain vitamins in our body: The gallbladder also helps absorb fat-soluble vitamins such as Vitamin K and Vitamin A from the small intestine.

Gallbladder Diseases

• Gallstones (cholelithiasis): Crystallisation of chemicals that are already present in bile may happen infrequently, but the reasons why this occurs are not completely understood or recognised at this time. They become crystalline and develop into gallstones or gallbladder stones. Even though gallstones are very common and rarely cause any symptoms, they can sometimes be painful, make you feel sick, or cause inflammation.
• Cholecystitis: infection of the gallbladder may lead to the production of gallstones, which can be very painful and cause fever. When the infection persists or returns, surgical intervention is required in such severe instances.
• Cancer of the gallbladder: Cancer may affect the gallbladder, despite the fact that the risk is minimal or perhaps nonexistent. In most cases, a diagnosis is not made during the early stages of the condition; rather, it is made at a later stage when symptoms become apparent. The symptoms are quite similar to those that are caused by gallstones.
• Gilbert: Gilbert syndrome is a genetic disorder that is often found to be present by chance, such as when a person goes in for a routine blood test. This condition is brought on by a malfunction in the way that the liver processes bilirubin.
• Choledocolithiasis: Stones may develop in the common bile duct when this disease is present. This condition is known as cholelithiasis.
• Cholangitis: Cholangitis is an illness that affects the bile ducts, which are the tubes that transport bile from the gallbladder and intestines to the liver. The liver is responsible for producing the juice known as bile, which is then used to digest meals.
• Gallstone ileus: When a stone travels through an enteric fistula, it may get lodged there, causing intermittent obstructive symptoms in the ileum. Some of these symptoms are nausea and throwing up, and they can eventually cause the small intestine to get blocked.
• Biliary Cysts: When there is cystic dilatation of the biliary tree, it causes the formation of biliary cysts. There are those linked to cholangiocarcinoma, rupture, stricture, cholangitis, and other conditions.
• Cholangiocarcinoma: when there is adenocarcinoma starting from anywhere but within the biliary tree, that is outside of the gallbladder or ampulla. Primary sclerosing cholangitis, cystic liver/biliary disease, parasite infection, and chronic liver disease such as intrahepatic cholangiocarcinoma are all risk factors.It can also cause jaundice, RUQ pain, and systemic signs like weight loss and fever.
• Gallbladder Cancer: It is a cancer of the gallbladder called adenocarcinoma. Those who suffer from chronic inflammation of the gallbladder, such as gallstones, chronic infection, or biliary cysts, are at a much increased risk. Jaundice, biliary colic, weight loss, and RUQ mass may be symptoms of biliary obstruction, which can sometimes present with a generic or ambiguous presentation.
• Gallstone pancreatitis: Because of the presence of impacted gallstones, there is a blocking of the ducts that drain bile juice to the pancreas, which causes inflammation of the pancreas. This is a serious problem because the pancreas is in charge of making many digestive enzymes, most of which help with digestion.
• Crigler-Najjar syndrome: The Crigler-Najjar syndrome is a very unusual genetic condition that is characterised by an inability to properly convert bilirubin and clear it from the body. This condition is extremely rare. The yellowing of the skin, mucous membranes, and whites of the eyes can become severe and pervasive in infants who are affected by this condition over time (jaundice). Even after the first three weeks of life, these symptoms are still present.
• Dubin-Johnson syndrome: This condition, which is also called Dubin-Johnson syndrome (DJS), is a genetic disorder that is harmless and can affect the liver. One of the main signs of this condition, which is passed down in a way called autosomal recessive inheritance, is the buildup of bilirubin, a substance that the liver normally gets rid of through the bile. DJS is caused by a change in the gene that affects the transporter protein that moves bilirubin, a normal byproduct of red blood cell breakdown, into the bile. After that, the bile leaves the body through the stoma.
• Rotor syndrome: Rotor syndrome is an autosomal recessive disease that is caused when biallelic inactivating mutations in SLCO1B1 and SLCO1B3 cause both OATP1B1 and OATP1B proteins to not function properly. This causes the disease to be passed down from one generation to the next. It is important to know that some changes can make it more likely that a medicine will have unwanted side effects.
• Primary Biliary Cholangitis: Primary biliary cholangitis is an ongoing illness that causes the gradual degradation and eventual loss of the microscopic bile ducts that are found in the liver. The medical term for this ailment is primary biliary cholangitis. When bile builds up in the liver because there are no bile ducts to evacuate it, the liver becomes damaged.
• Cholangitis: Inflammation (swelling) of the bile duct is the medical definition of cholangitis. caused by a gallbladder or other infection.
• Gallstone ileus: it is a disease which evolves when a stone in the ileum obstructs the bowel passage.
• Biliary colic: the contraction of smooth muscle in the wall of the gallbladder, which occurs when the gallstone is trying to be expelled, is the typical cause of this condition. It is episodic and is at its worst when a stone (calculus) is impacted either at the terminal end of the cystic duct or at the lower end of the bile duct.
• Obstruction of CBD: The obstruction of CBD is typically caused by gallstones, pancreatic carcinoma, or enlarged neoplastic hepatic lymph nodes. In rare cases, it can also be caused by cancer of the pancreas. Because it blocks the flow of bile, it makes the person get jaundice.

Gallbladder Tests

• Abdominal ultrasound: An innocuous probe is put on the patient’s skin, and high-frequency sound waves are used to reflect off of various anatomical structures in the abdomen. The USG test is considered to be the gold standard for both the diagnosis of gallstones and the examination of the gallbladder wall.
• HIDA scan (cholescintigraphy): A radioactive dye is injected intravenously as part of this nuclear medicine test. The radioactive dye is then excreted in the bile. Cholecystitis is highly likely to occur if the scan reveals that bile does not travel from the liver to the gallbladder.
• Endoscopic retrograde cholangiopancreatography (ERCP) for cholecystitis: During this procedure, a catheter is inserted into the hepatopancreatic ampulla. After that, radiopaque contrast medium is injected, and the bile and pancreatic ducts are visualised. This procedure is performed under direct vision through a fiber-optic endoscope. In the event that ERCP is unsuccessful, a radiological procedure known as percutaneous transhepatic cholangiography is used to visualise the biliary tract.
• Magnetic resonance cholangiopancreatography (MRCP): A high-resolution image of the bile ducts, pancreas, and gallbladder can be obtained through the use of an MRI scanner. The images obtained from the MRCP help guide subsequent diagnostic procedures and treatments..
• Endoscopic ultrasound: After making an incision in the patient’s mouth, a thin ultrasound probe that is attached to the end of a flexible tube is then inserted into the patient’s intestines. Choledocholithiasis and gallstone pancreatitis are both conditions that can be diagnosed with the assistance of endoscopic ultrasound.
• Abdominal X-ray: In most cases, X-rays are unable to correctly diagnose gallbladder disease. However, X-rays can be helpful in locating other abdominal problems. On the other hand, gallstones might be visible on an X-ray.
• Cholecystography: The gallbladder itself is not opaque to X-rays; however, when certain radiopaque dyes are administered, either orally or intravenously, the dyes are excreted by the liver from the blood into the bile, which then travels to the gallbladder. Because of the dye’s increased concentration in the gallbladder, this organ appears opaque when examined by X-rays

Gallbladder Treatments

• Gallbladder surgery (cholecystectomy): A surgeon removes the gallbladder, using either laparoscopy (several small cuts) or laparotomy (traditional “open” surgery with a larger incision).
• Chemotherapy and radiation therapy for gallbladder cancer: After surgery for gallbladder cancer, chemotherapy and radiation may be used to help prevent cancer from returning.
• Extracorporeal shock-wave lithotripsy for cholelithiasis: High-energy shockwaves are projected from a machine through the abdominal wall, breaking up gallstones. Lithotripsy works best if only a few small gallstones are present.
• Contact solvent dissolution: A needle is inserted through the skin into the gallbladder, and chemicals are injected that dissolve gallstones. This technique is rarely used.
• Percutaneous cholecystostomy: Percutaneous cholecystostomy (PC) is used to treat gallbladder diseases such as cholecystitis or cholangitis, malignant or benign biliary blockage, gallbladder perforation, and percutaneous biliary stone removal.
• Endoscopic sphincterotomy: Biliary endoscopic sphincterotomy (EST) is the cutting of the biliary sphincter and intraduodenal portion of the common bile duct after selective cannulation with a high frequency current administered with a sphincterotome introduced into the papilla.
• Enterolithotomy: The goal of gallstone ileus therapy is to remove the blockage by enterolithotomy. Because it has a lower morbidity and mortality rate than the other procedures, it is the preferred treatment for gallstone ileus care.
• Hepaticojejunostomy: The hepatic duct is a tubular conduit that transports bile from the liver to the small intestine. A hepaticojejunostomy is a surgical technique that creates an anastomosis (connection) between the hepatic duct and the jejunum, the middle region of the small intestine.

Gall bladder medicines

• Ursodeoxycholic acid for gall stone: It helps in dissolution of the gallbladder stone as it decreases small cholesterol gallstones and reduce the symptoms of it it is helpful in both oral tablets and syrup solutions comes in the market from variety of pharmaceutical companies
• Antibiotics for cholecystitis: Antibiotics, in combination with other treatments, may be used to treat an infection caused by H. pylori. During treatment, the antibiotics are given to the stomach in an effort to heal the damage caused by the infection. Some of the examples include metronidazole ceftriaxone and sulphabactum
• Antiparasitic drugs for cholecystictis: In the treatment of parasites, some examples include metronidazole, praziquantel, and albendazole. In the treatment of bacterial infections, some examples include azithromycin, ciprofloxacin, and tetracycline.
• Antiviral Medications for cholecystictis: A number of antiviral drugs, such as entecavir, tenofovir , lamivudine , adefovir , and telbivudine, can aid in the fight against the virus and lessen its ability to harm your gall bladder.
• Hepatic Rejuvenation Medicine: including n-acetyl cysteine, trypsin, and vitamin K, are used as adjuvant therapy for the treatment of a wide range of hepatocellular diseases.
• Chemotherapeutic Drugs for gall bladder carcinoma: Chemotherapy and radiation are effective treatments for gall bladder cancer, despite the disease’s untreatable nature. In extreme cases, the gall bladder may be removed surgically or replaced with a donor organ.
• Statins for cholelithiasis: This class of drugs is known as lipid-lowering medicines, and it has other beneficial properties for slowing the development of acute or chronic gall bladder disease, such as lowering oxidative stress and inflammation. Rosuvastatin, atorvastatin, etc., are all instances of statins.
• Corticosteroids for cholecystictis: Drugs with anti-inflammatory properties work by preventing the recruitment of polymorphonuclear leukocytes (PMNs) to areas of cellular and tissue injury, hence reducing inflammation. Methylprednisolone is an example of an effective corticosteroid.

What is acute cholecystitis – symptoms, diagnosis, treatment in NCC №2 (CCH RAS)

Cholecystitis is a serious complication of cholelithiasis, which is expressed in inflammation of the gallbladder.

Why do we need a gallbladder

In an average person, the liver synthesizes about 800 ml of bile per day. Bile is collected through the bile ducts, which look like tree branches. The trunk of this tree is called the common bile duct, or common bile duct . It passes behind the duodenum, inside the head of the pancreas, and opens at the end of the duodenum as the major duodenal papilla.

Since we do not eat around the clock, then for the “storage” of additional portions of bile in the intervals between meals, there is gallbladder . It is a blind sac extending from the common bile duct, which holds 50-70 ml of bile. With a reflex contraction of the gallbladder during a meal, an additional portion of bile enters the duodenum and is involved in the breakdown of fats.

How cholecystitis occurs

In some people, the delicate mechanism of contraction of the gallbladder is disturbed: bile stagnates in it, water is absorbed from the bile. As a result, a supersaturated solution is formed in the lumen of the gallbladder, conditions are created for precipitation in the form of stones.

When eating spicy, fatty, fried foods, there is an increased reflex contraction of the gallbladder and ducts, as a result of which stones can be displaced. And if the stone is large enough, then it gets stuck in the neck of the gallbladder, blocking the lumen. Fluid begins to accumulate in the gallbladder, squeezing the bladder from the inside.

In response to inflammation, leukocytes rush into the lumen of the gallbladder, which quickly turns its contents into pus. The patient has a clinical picture of acute cholecystitis :

• Acute pain in the right hypochondrium
  It occurs due to the fact that the gallbladder is located under the liver, growing into it on one side. The liver, in turn, is attached to the right dome of the diaphragm, so the pain is aggravated by taking a deep breath (Murphy’s symptom).
• Nausea, vomiting
  The vagus nerve (one of the longest nerves in the body) ends in the gallbladder, which reflexively causes vomiting.
• Attack of “angina pectoris” (appearance of retrosternal pain and shortness of breath)
  This effect is caused by the action of the vagus nerve on the heart muscle.

Acute occlusive cholecystitis

A stone stuck at the exit from the gallbladder causes its occlusion (impaired patency). Because of this, the gallbladder begins to increase in volume, gradually turning into an abscess.

Further events can develop according to several scenarios:

Option No. 1. Stone displacement due to the use of antispasmodics

Antispasmodic drugs reduce the tone of the gallbladder wall, as a result of which the stone can move. The pressure inside the lumen of the gallbladder decreases, and the attack of acute cholecystitis subsides.

But experience shows that an attack once happened is almost always repeated. This is due to the fact that gallstones at the time of inflammation damage the mucous membrane. “Inflammatory mediators” are released from it – substances that contribute to the conversion of lecithin to lysoleucitin. It is this substance that is contained inside the gallbladder, and is recognized as responsible for the recurrence of the disease.

It is strongly not recommended to dissolve stones in the gallbladder with the help of special preparations. Large stones break into small pieces and begin to migrate through the bile ducts, which is extremely dangerous. Even if you remove all the stones from the gallbladder, the conditions for their formation will not disappear anywhere: the stones form again.

Option #2 Stone stuck at gallbladder exit remains in place despite treatment

In this case, the gallbladder begins to increase in size, squeezes itself from the inside, its wall swells, thickens, and malnutrition occurs in it. This is clearly visible on ultrasound: if the thickness of the gallbladder wall is normally 1-3 mm, then in case of inflammation it can increase to 5-8 mm or more, delaminate, become denser.

In response to inflammation, leukocytes enter the lumen of the gallbladder, and the bile contained inside it quickly turns into pus. The gallbladder overflowing with pus can burst with the development of purulent peritonitis (inflammation of the entire abdominal cavity). Without timely treatment, death is possible.

Variant No. 3. Occurrence of choledocholithiasis

If there are small stones in the gallbladder, then when it contracts, they begin to move inside the lumen. Then, bypassing the exit from the gallbladder, they enter the common bile duct. These stones create an obstacle to the free flow of bile into the duodenum, which leads to an increase in pressure within the entire biliary system. The ducts expand, and an excess of bile pigments (bilirubin) at the cellular level leads to the fact that it rushes into the blood. There is a so-called mechanical jaundice.

All together quickly leads to disruption of the functioning of the liver. Due to the destruction of the cell wall, enzymes appear in the blood, which are normally found inside the liver cells.

Due to a violation of the continuous outflow of bile into the duodenum, microorganisms enter the bile ducts and the bile turns into pus. There is inflammation of the bile ducts – purulent cholangitis .

If the necessary measures are not taken in time, abscesses associated with the bile ducts form in the liver. This is a dangerous, life-threatening situation: in order to save the patient, the clock counts down.

Option No. 4. Danger of large stones

Having reached a certain critical size, the stones, due to their gravity, begin to squeeze the wall of the gallbladder and cause a violation of the blood supply. A bedsore is formed – a hole in the gallbladder. If the common bile duct is nearby, an additional message is formed between it and the gallbladder, the so-called Mirizzi syndrome. This is an extremely dangerous situation in which attacks of purulent cholangitis can occur.

To prevent the development of events according to all the described options, prophylactic cholecystectomy is carried out in patients with cholelithiasis – removal of the gallbladder outside the period of exacerbation.

What happens to a person when he comes to a surgical hospital with acute cholecystitis

1. Examination by the surgeon on duty in the emergency room
2. Blood and urine tests
3. Abdominal and thoracic surveys
4. Abdominal ultrasound. Ultrasound examination allows assessing the size of the gallbladder, wall thickness, the presence of its stratification, the size, number and location of stones, the presence of infiltration and free fluid in the abdominal cavity
5. Gastroscopy. Inflammation of the gallbladder is often associated with acute erosive gastritis, duodenitis and the risk of bleeding

Based on the clinical picture, ultrasound data, laboratory test results, a decision is made on further treatment tactics:

1. Conservative therapy

In the absence of signs of destruction of the gallbladder wall, the patient is admitted to the hospital and an intravenous catheter is installed for infusion therapy. It is aimed at stopping inflammation, relaxing the walls of the gallbladder, reducing pain and preventing stress ulcers. A day later, a control ultrasound is done to assess the effectiveness of the therapy.

1. Surgery

If the size of the gallbladder has decreased, the stone has moved away from the neck, the swelling of the wall has decreased, then you can continue conservative treatment and perform an operation a few days after the exacerbation subsides. If during the control ultrasound the situation has not changed, or worsened, this is an indication for an urgent operation.

Cholelithiasis – Clinic 29

Gallstone disease (GSD) is a disease in which stones form in the gallbladder or bile ducts. Gallstone disease has been known since ancient times. Galen also discovered gallstones during the autopsy of corpses. Mentions of cholelithiasis are found in the writings of doctors of the Renaissance. Currently, every tenth inhabitant of our planet suffers from gallstone disease, and this disease of civilization is becoming a social problem.

Causes of gallstone disease

Gallstone disease in both adults and children is a multifactorial disease. The main factors are:

• Malnutrition
• Poor drinking water
• Heredity
• Physical inactivity
• Bad habits
• Disruption of intestinal microflora
• Stress
• Uncontrolled intake of drugs, etc., that is, all those factors that lead to metabolic disorders, especially cholesterol metabolism.

Leading links in the process of stone formation: stagnation of bile in the gallbladder and an increase in the concentration of salts in bile due to metabolic disorders.

Can cause gallstone disease:

• overeating, starvation, irregular meals;
• sedentary lifestyle, especially sedentary work;
• pregnancy;
• taking hormonal contraceptives;
• obesity;
• biliary dyskinesia;
• diseases of the pancreas.

Clinical picture

There are three variants of the clinical picture of cholelithiasis:

• asymptomatic lithiasis;
• clinical manifestation, manifested by abdominal pain and dyspeptic disorders;
• gallstone colic.

Asymptomatic stone carrying is assumed when there are no complaints and stones in the gallbladder (ducts) are an incidental diagnostic finding, more often on ultrasound. Unfortunately, the stones do not dissolve by themselves, and the disease will manifest itself in other forms over time.

Abdominal pain and dyspeptic disorders are the main complaints. In adults, pain is usually in the right hypochondrium, more often in the form of a feeling of heaviness and is provoked by a violation of the diet (overeating, fatty, fried foods). The nature of the pain depends on the size of the stones. Dull, drawing, vague pains are characteristic of patients with single stones or large stones. Multiple, small, easily moving stones, as a rule, give acute paroxysmal pain – gallstone colic.

Sometimes a small stone passes from the gallbladder into the bile ducts. In this case, an attack of gallstone disease occurs: there is a sharp pain in the right hypochondrium or in the upper abdomen. It can “give” to the right collarbone, right arm or back under the shoulder blade. In this case, bitterness appears in the mouth, nausea and vomiting, which does not bring relief, the sclera of the eyes may turn yellow. If the stone (with a relatively small size) was able to bypass the ducts and fall into the duodenum, the attack stops on its own, and the stone comes out with feces. Otherwise, there is a blockage of the biliary tract and there is a danger of developing acute cholecystitis and mechanical (subhepatic) jaundice. In this case, in addition to the typical picture of colic, yellowness of the skin, discolored stools, and dark urine appear. Pain can spread to other areas of the upper abdomen, often there are “girdle” pains – a sign of blockage not only of the biliary tract, but also of the pancreatic duct. Obturation (blockage) of the excretory ducts is a very dangerous condition!

Diagnosis of cholelithiasis

Diagnosis is based on the clinical picture, on examination of the patient – the doctor can determine tenderness at specific points, on changes in blood and urine tests in the presence of inflammation in the gallbladder and / or a violation of the outflow of bile. Ultrasound reveals formations in the gallbladder, but with symptoms of severe cholecystitis (inflammation), stones may not be visible, ultrasound does not always detect stones that have entered the ducts. Then X-ray methods of research are used: retrograde cholecystopancreatography (RCPG) is the most common method.

Treatment of gallstone disease

The tactics of treatment of cholelithiasis is determined by the clinical picture, the position of the stones and the timing of the patient’s request for medical help. Non-surgical methods of treatment are rarely used, mainly in children during the period of hormonal instability, in adults in the preoperative period. In case of cholelithiasis, it is prescribed:

• diet with the exception of fatty, fried, smoked, spicy. Food should be fractional, without overeating. Particular importance is attached to the use of vegetables and fruits, wheat bran and other foods containing dietary fiber. They bind bile acids in the intestine, which promotes their synthesis in the liver.
• motor mode: we avoid both hypodynamia and excessive physical exertion. Walking, table tennis, billiards are shown.
• Cholagogue preparations, herbs and tubes are contraindicated!

Surgical treatment

If you have applied for a planned appointment outside the acute phase of gallstone disease, the stones are located only in the gallbladder, and not in the ducts, then you will perform a laparoscopic cholecystectomy (removal of the gallbladder). If stones are localized only in the gallbladder, radical surgery – cholecystectomy in most cases leads to a permanent cure for cholelithiasis. Cholecystectomy is a pathogenetically substantiated operation: the shock organ is removed, i.e. already a defective organ with impaired function and a constant source of infection. All this leads to an acceleration of the circulation of bile acids between the intestines and the liver, a decrease in the stone-forming properties of hepatic bile, and the prevention of the formation of gallstones.

If you delayed the operation for cholelithiasis or tried to “expel” the stones and there was an obstruction of the biliary tract. Such a situation can end with a laparotomy (large abdominal incision), sometimes even with the removal of part of the biliary tract and the imposition of various non-physiological, but vital, connections between organs for the outflow of bile.

Do not be afraid of the operation! The only radical way to treat gallstone disease is to remove the diseased gallbladder. Currently, a special technique has been developed for laparoscopic surgery (the operation is performed using several punctures of the abdominal wall). It is less traumatic, and the patient can get up on the day of the operation. The cosmetic effect is also important – the absence of seams on the body. This issue is especially of concern to girls, because no one wants past illnesses and operations to be read on his body.
After removal of the gallbladder, you can safely return to normal life and practically do not adhere to any diet.

Complications of cholelithiasis

– Infections. The most serious complication of acute cholecystitis caused by gallstones is infection, which occurs in about 20% of cases.

– Gangrene and abscess. Severe inflammation can cause abscess and necrosis (destruction) of tissue in the gallbladder, leading to gangrene. At high risk are men over 50 who have a history of cardiovascular disease.

– Perforation (rupture) of the gallbladder. An estimated 10% of cases of acute cholecystitis due to gallstones have gallbladder perforation, a life-threatening condition. In general, it occurs in people who have not sought help for too long, or in people who do not respond to treatment. Gallbladder perforation is most common in people with diabetes. After the wall of the gallbladder has been perforated, the pain may temporarily decrease. This dangerous delusion threatens with the development of peritonitis and the spread of infection into the abdominal cavity.

– Empyema. Pus in the gallbladder (empyema) occurs in 2 to 3% of patients with acute cholecystitis. Patients usually experience abdominal pain for more than 7 days. Physical examination often does not always immediately reveal the cause. Empyema can be life-threatening, especially if the infection spreads to other parts of the body.

– Fistula. In some cases, inflammation of the gallbladder spreads and results in perforation of nearby organs, such as the small intestine. In such cases, a fistula is formed between the organs, which is a channel or opening. Sometimes, in such cases, gallstones may actually pass into the small intestine. This can be very serious and requires immediate surgery.

— Gallstone obstruction. Gallstone blockage of the bowel is known as gallstone ileus. It primarily occurs in patients over 65 years of age and can sometimes be fatal. Depending on where the stone is located, surgery may be required to remove it.

– Infection of the common bile duct (cholangitis). Infection of the common bile duct is a very dangerous serious disease. If antibiotics are given immediately, the infection is cured in 75% of patients. If cholangitis is not stopped, the infection can spread and become life-threatening.

– Pancreatitis. Common bile duct stones are responsible for most cases of pancreatitis (inflammation of the pancreas).

– Cancer of the gallbladder. Gallstones occur in about 80% of people with gallbladder cancer.