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Gallbladder Complications

What are the symptoms of Gallstones or Gallbladder Disease?

As gallstones move into the bile ducts and create a blockage, pressure increases in the gallbladder and one or more symptoms may occur. Symptoms of blocked bile ducts are often called a gallbladder “attack” because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause:

  • steady pain in the right upper abdomen or just below the breastbone that increases rapidly and lasts from 30 minutes to several hours
  • nausea and occasional vomiting
  • pain in the back between the shoulder blades
  • pain under the right shoulder

Although these attacks often pass as gallstones move or dislodge, gallstones can lead to more serious complications.

Many people with gallstones have no symptoms; these gallstones are called “silent stones.” They do not interfere with gallbladder, liver, or pancreas function and do not need treatment.

Gallstones can cause many complications, from mild to severe as listed below.

Biliary Colic

When the gallbladder contracts, gallstones may get pushed forward into the cystic duct (the tube where bile usually flows out of the gallbladder into the main common duct). A stone trapped in the cystic duct will then block the flow of bile out of the gallbladder. This leads to biliary colic. Symptoms of biliary colic usually result in an “attack” which can consist of : 1) right sided upper abdominal pain, 2) pain just below the breast bone 3) abdominal bloating 4) nausea and or vomiting 5) pain in the back or shoulder. These symptoms usually resolve or abate over a few hours once the stone passes out of the cystic duct; and, either flows back into the gallbladder itself (where it can cause another attack) or moves down and out through the bile system. Patients with biliary colic usually do not have abdominal tenderness.

Biliary colic is recurrent. After your initial attack, it is highly likely that you will sustain more attacks. Further, these attacks may not be simple biliary colic attacks but can progress to more serious gallbladder complications.

The treatment for biliary colic is an elective removal of the gallbladder. Elective meaning that the surgery can be performed as an outpatient (no need to stay overnight in the hospital) and generally within 4 to 6 weeks after symptoms begin. Waiting longer increases the chances of similar attacks or more severe complications occurring.

Acute Cholecystitis

The same mechanism that causes biliary colic is responsible for acute cholecystitis. The difference is that the stone gets lodged or stuck in the cystic duct and cannot move. This leads to an infection. Symptoms are similar to biliary colic but differ in the following ways: 1) fever may be present, 2) significant tenderness to the right upper abdomen and/or just below the breast bone are present, 3) the symptoms do not resolve in a few hours, 4) the symptoms are more severe than previous attacks.

Acute cholecystitis usually requires a hospitalization for intravenous antibiotics. Further, surgery is usually performed during the same hospitalization.

Gallstone Pancreatitis

Gallstone pancreatitis occurs when a stone passes out of the cystic duct, travels down the main bile duct, and then irritates the pancreatic duct. This causes pancreatitis. There are many causes of pancreatitis but when it is related to gallstones, it is called gallstone pancreatitis. Pancreatitis is a very serious complication from gallstones and can lead to serious medical problems.

Once the pancreatitis resolves, gallbladder removal needs to be performed to prevent further episodes. Usually, gallbladder surgery is performed prior to leaving the hospital as there is a very high probability of the pancreatitis returning.

Jaundice

If a stone passes through the cystic duct, but then gets stuck ort lodged in the main bile duct, jaundice can occur. Jaundice results as the bile backs up into the liver due to the stone obstruction. If the stone breaks free on its own and passes through the bile system, jaundice will resolve. If the stone does not move, a procedure called an ERCP (Endoscopic Retrograde CholangioPancreatography) will need to be performed by a gastroenterologist in order to retrieve the stone and alleviate the obstruction or blockage. The gastroenterologist places a camera through your mouth and guides it down into the duodenum (the part of the intestine where the bile comes out). He or she will then place an instrument into the bile duct opening in order to remove the stone or stones that are stuck in the main bile duct.

Once the duct is cleared, the gallbladder needs to be removed as other stones are likely to become lodged as well and cause further episodes of jaundice.

Biliary Dyskinesia

Dyskinesia is defined as an abnormality of voluntary movement. In biliary dyskinesia, the gallbladder is not functioning properly leading to poor or improper contractions (voluntary movements).

Symptoms develop because the gallbladder is not contracting correctly or not contracting at all. Thus, bile is not able to leave the gallbladder which leads to symptoms similar to biliary colic. Symptoms of biliary dyskinesia can consist of: 1) right sided upper abdominal pain, 2) pain just below the breast bone 3) abdominal bloating 4) nausea and or vomiting 5) pain in the back or shoulder. The difference between biliary dyskinesia and biliary colic is that, in dyskinesia, no stones are present in the gallbladder.

Biliary dyskinesia is usually diagnosed with a HIDA scan. A HIDA scan is a nuclear medicine test that measures how well the gallbladder empties bile out of the gallbladder into the main common duct. Normal emptying (or ejection fraction) of the gallbladder is around 35%. If the ejection fraction is lower (less than 20%), this usually signifies biliary dyskinesia. When the ejection fraction is low, the gallbladder is not emptying correctly. Bile is not able to be exit the gallbladder and this causes symptoms similar to biliary colic.

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