Last updated: March 3, 2017

Gall Bladder Symptoms

Gallbladder symptoms infographic

Gallbladder Symptoms: An overview

Gallbladder symptoms include symptoms of several different types gallbladder diseases. Gallbladder symptoms in any individual patient not only depend on the particular type of gallbladder disease but also depend upon the patient’s age and other medical problems. Gallbladder symptoms from acute cholecystitis are different from the gallbladder symptoms from biliary colic. Similarly gallbladder symptoms from acute cholangitis are different from gallbladder symptoms from gallstone pancreatitis.

The several different types of diseases that can cause gallbladder symptoms have various degrees of seriousness and need different treatment. I will briefly describe the different types of diseases causing gallbladder symptoms on this page. I have included links to articles with examples from real patients with gallbladder symptoms that I took care of. The real life examples will help you understand gallbladder symptoms better.

Where is gallbladder located? Where is gallbladder pain felt?

Gallbladder is located in the right upper quadrant of your abdomen. To understand gallbladder location, you can divide your abdomen into four equal parts: right and left with a vertical midline and upper and lower with a horizontal line through the middle of your abdomen. Your gallbladder will be found in the right upper part. To be exact, gallbladder is located just behind your 9th rib on the right side. The front and top side of the gallbladder is located just under the lower border of the liver. The back and lower side of the gallbladder is located on top of your intestines.

gall-bladder-symtoms

Image courtesy of: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

To understand where gallbladder pain is felt, you need to know the nerve supply of the gallbladder. Gallbladder does not have sensitive pain nerves like the ones in your skin. Like other internal organs, gallbladder gets its nerve from the autonomic nervous system. These nerves produce difficult to pinpoint vague pain sensation. However, the inside surface of your abdomen has sensitive nerves.

At first, gallbladder pain may be felt in the middle of your upper abdomen near your stomach. As your gallbladder gets more inflamed, it causes irritation in the inside surface of your abdomen. At that time, gallbladder pain is felt where the gallbladder is located. You will then feel the typical right upper quadrant pain under ribs.

The gallbladder is a small pouch that collects bile juice from the liver. Bile is made by liver and is collected by small tubules that eventually come together and form the common bile duct. As the common bile duct travels towards the upper part of the intestine where it releases the juice, it gives off a small branch called the cystic duct which connects to the gallbladder. Gallbladder serves to collect and hold the excess juice until it is needed in the intestine for help in digestion of the food. When it is needed, gallbladder contracts and empties its contents. Gallbladder symptoms develop when there is some defect in this mechanism. Anything that obstructs the path of bile flow, anything that causes over distension or anything that causes turbulence and infection in the sac can produce pain and other gallbladder symptoms.

Biliary colic

Biliary colic is usually self limited and is the mildest form of gallbladder symptoms. It occurs when there is something that stops the outflow of bile from the gallbladder. Treatment for biliary colic may not require hospitalization.

A small stone or some turbulent sludge may obstruct the neck of the pouch and prevent bile from coming out. When the patient eats fatty food, it creates an stimulus for the gallbladder to contract to try to empty its contents. It then gets distended. The pain is usually located in the middle or right side of the upper abdomen. These types of “gallbladder attacks” may last for a few hours. Patients may feel intense pressure like discomfort that may radiate to the right shoulder. Other than gallbladder pain, symptoms may include nausea and vomiting.

Here is an example of a patient with biliary colic.

Cholecystitis symptoms

Acute cholecystitis symptoms are usually more severe than gallbladder symptoms from biliary colic. The mechanism of development of acute cholecystitis symptoms is initially similar to biliary colic but it gets more complicated later. In addition to the obstruction and distension that happens just like I described for the patients with biliary colic, patients with acute cholecystitis develop inflammation or infection of the gallbladder wall. This inflammation in cholecystitis causes worse pain and fevers. The gallbladder becomes tender and inflamed with acute cholecystitis. Diagnosis is made with blood tests and imaging. The blood tests show signs of inflammation. Acute cholecystitis treatment may require hospitalization with antibiotics and possible surgery. Immediate gallbladder pain relief may require administration of intravenous pain medications.

Here is an example of a patient with acute cholecystitis.

Gallbladder symptoms from acute cholangitis

Gallbladder symptoms from from acute cholangitis can be life threatening and need emergent treatment. The obstruction in acute cholangitis is at the common bile duct, not at the neck of the gallbladder. In patients with gallbladder symptoms from acute cholangitis, the bile can not flow downstream to the intestine at all. It then causes backflow of the bile into the liver and ultimately into the blood causing yellowing of the skin and the eyes. This yellow discoloration is called Jaundice and is one of the symptoms that separates gallbladder symptoms of cholangitis from that of biliary colic and acute cholecystitis. In cholangitis, the complete obstruction of bile causes severe inflammation and damage of the liver tissue. Patients may have severe pain. Cholangitis can be fatal if not treated urgently.

Here is an example of a patient with acute cholangitis.

Gallbladder symptoms from gallstone pancreatitis

Gallstone pancreatitis causes inflammation in the pancreas. Symptoms of gallstone pancreatitis are usually more severe than symptoms of cholecystitis. In addition to causing obstruction in the flow of bile, small stones from gallbladder can lodge off and cause inflammation of the pancreas. The exact mechanism is somewhat complex but the inflammation of pancreas can be very severe and dangerous. Patients with gall stone pancreatitis have very severe pain right in the middle of the stomach. Pancreatic pain may be felt all the way to the back. Patients with gallstone pancreatitis may require special procedure to remove the obstructing gallstones. Treatment requires hospital admission and specialist consults.



Gallbladder cancer symptoms:

Gallbladder cancer symptoms are very hard to detect. Most patients with gallbladder cancer do not have any symptoms until the cancer has spread causing metastatic disease. Gallbladder cancer symptoms from those metastatic diseases may depend on the location and extent of the metastatic disease.

Gallbladder cancer symptoms may also be hard to distinguish from other types of gallbladder symptoms. For example, patients thought to have cholecystitis symptoms may be found to have gallbladder cancer. After surgery for acute cholecystitis, the gallbladder tissue is sent to the lab for biopsy. Sometimes, early gallbladder cancer is detected incidentally after surgery for cholecystectomy. If the cancer is limited to the gallbladder at the time of diagnosis, Gallbladder cancer survival rate is very good. That’s why it’s important to follow up the biopsy result after any gallbladder surgery. Gallbladder cancer life expectancy is very poor with metastatic disease.

Like many other diseases discussed here, gallbladder symptoms depend upon how other organs and overall health of the patient contribute in the development of gallbladder symptoms in that particular patient. That is why you have to really understand the circumstances under which the patient developed the gallbladder symptoms to clearly understand how gallbladder symptoms develop in any particular patient. I encourage you to follow the links with real life examples.