Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The pain of gallbladder disease almost always has one of two
causes - gallstones or
cholecystitis. Gallstones are stones that form in the
gallbladder (often misspelledgall bladder). They vary in size from a millimeter or two to several centimeters
and are made up of cholesterol or pigment. Cholecystitis means inflammation of
the gallbladder. Although, cholecystitis is most commonly caused by gallstones,
there are other less common causes as well.
What is the mechanism of gallbladder pain?
Gallstones have a tendency to become lodged in the bile ducts leading from
the gallbladder or liver, and into the intestines. When gallstones lodge in the
ducts, they give rise to a specific type of pain calledbiliary colic. The
characteristics of biliary colic are very consistent, and it is important to
recognize its characteristics because they direct the physician to the most
appropriate test to diagnose gallstones, primarily abdominal ultrasonography. In
approximately 5% of cases, ultrasonography will fail to show gallstones. In such
situations, if the characteristics of biliary colic are typical, physicians will
go on to other more advanced tests for diagnosing gallstones, specifically
endoscopic ultrasound. Finally, most gallstones do not cause pain, and are
frequently found incidentally during abdominal ultrasonography. If the symptoms
for which the ultrasonography is being done are not typical of biliary colic, it
is unlikely that the symptoms are caused by gallstones. The gallstones can be
truly silent. This is important to recognize because surgery to remove the
gallstones is unlikely to relieve the symptoms.
When gallstones lodge suddenly in the duct leading from the gallbladder
(cystic duct), the duct leading from the liver to the cystic duct (common
hepatic duct), or the duct leading from the cystic duct to the intestine (common
bile duct), the normal flow of bile from the liver is interrupted. With
obstruction of the common hepatic or common bile duct, the backup of bile causes
the ducts (and the gallbladder in the latter case) to distend. This distention
(stretching) is the cause of the biliary colic. When obstruction of the cystic
duct occurs, fluid is secreted into the gallbladder causing it to distend.
Again, the distention causes biliary colic. Biliary colic stops when the
gallstone unlodges from the duct.
Medical Author: Jay W. Marks, MD Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Viewer question: My sister had her gallbladder removed recently. What kind of diet will she need to be on, and will she now be at greater risk for heart disease?
Doctors response: The gallbladder is a sac that
stores bile made by the liver in between meals. After a meal, the gallbladder
squeezes the bile it has stored into the intestine. In the intestine, the bile
mixes with food and fat. Bile is important because it helps with the digestion
of fat and its transfer from the intestine into the body.
When the
gallbladder is removed, bile made by the liver can no longer be stored between meals.
Instead, the bile flows directly into the intestine anytime the liver produces it.
Thus, there still is bile in the intestine to mix with food and fat.
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