The next time you complain of gastric pain, think twice before dismissing it offhand. That sporadic pain in the centre of your upper central abdomen, which seems to get worse at times, could be a symptom of gallbladder disease.
"The gallbladder is a small sac on the underside of the liver that is used to store bile, which is produced by the liver to aid in fat digestion," explains Dr Victor Lee Tswen Wen, consultant surgeon (Hepatobiliary & Transplant) at the Department of General Surgery at Singapore General Hospital.
"Bile consists of water, cholesterol, bile salts, fats, proteins and bilirubin (a yellowish-brown pigment)," adds Lee. "If the liquid bile contains too much cholesterol or bilirubin, it can harden into gallstones."
Gallstones are the most common result of gallbladder disease. Lee says: "When formed, gallstones can be of varying number and size. Some are as small as a grain of sand, while others are as big as golf balls."
Types of gallstones
There are three main types of gallstones, and their formation is affected by factors such as age, diet and ethnicity.
- Cholesterol stones: Made of hardened cholesterol, these are yellowish in colour. In Western countries, most gallstones feature cholesterol stones.
- Pigment stones: Made of bilirubin, these are small, dark-coloured stones most commonly seen in the developing world.
- Mixed stones: These are a combination of cholesterol and pigment stones. In Singapore, most gallstones feature mixed stones.
Gallstones cause the aching discomfort that so many people mistakenly assume to be gastric pain. "It is important to make the distinction between gastric pain (or peptic ulcer disease) and gallbladder disease as the treatment is very different," says Lee.
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Do I have gallbladder disease?
"The symptoms of gallbladder disease vary widely," says Lee. "It depends on which of the three clinical stages of gallbladder disease you are experiencing — asymptomatic, symptomatic or complicated."
At the asymptomatic stage:
There are no symptoms. At this stage, gallstones are usually incidentally detected during screening. They do not interfere with liver, gallbladder or pancreas function, so treatment is typically not necessary.
At the symptomatic stage:
As gallstones block the bile ducts, pressure increases in the gallbladder. This can cause an "attack" of sporadic pain in the centre of the upper abdomen called biliary colic, which is often confused with gastric pain. It typically follows heavy or fatty meals, and can occur at night.
A typical attack usually results in steady pain in the centre of the upper abdomen. The pain can increase rapidly and can last 30 minutes to several hours. There might also be pain in the back between the shoulder blades, and under the right shoulder.
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At the complicated stage:
Acute gallbladder disease is one of the most frequent causes for emergency hospital admissions. This includes jaundice due to obstructed bile ducts, acute cholecystitis (inflammation of the gallbladder) and acute pancreatitis.
When the gallstones obstruct the common bile duct, you can get jaundice. Symptoms include a yellow discolouration of the skin and whites of eyes, itchy skin, pale bowel motions and dark urine.
Patients with acute cholecystitis will have a persistent right or upper abdominal pain, and fever. This pain can be made worse by movement or coughing. Nausea and vomiting are also common.
Typically, patients with acute gallstone pancreatitis will present with sudden severe upper abdominal pain, often associated with back pain. The pain is usually severe enough to bring the patient to the emergency room. If the gallstones obstruct the pancreatic duct there may be back pressure in the pancreas, causing pancreatitis. Most attacks of pancreatitis are mild, while some are severe and life-threatening.
It's time to consult a doctor if you have…
- Prolonged abdominal pain lasting more than four hours
- Nausea and vomiting
- Fever and chills
- Yellowing of the skin and whites of the eyes
- Pale-coloured stools
Lee explains: "Any of the above symptoms may signal complicated gallbladder disease, which warrants immediate attention."
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