Right Upper Abdominal Pain Caused By Gall Bladder Stone Impaction
You woke up suddenly at night or even minutes to a few hours after having a meal with pain on the right upper abdomen. Initially you wondered if this is wind or muscle pain or something else. Within minutes, the pain becomes more intense.
It is there. Localized to just under or around your right breast. The pain continues to worsen and spreads like a squeezing pain or stabbing knife through the right side of your lower chest and upper abdomen towards your back.
The pain may also spread up to the tip of your right shoulder or down to the bottom of your right shoulder blade bone behind.
You walk about or roll around, looking for a position of comfort, or even coiling up to help ease the pain.
Nauseated. You may actually vomit, and sweating like you never have before.
What is this? Could I be having a heart attack? Or is it something that I have eaten? As you pace around looking for help, the pain gradually subsides and after a few more minutes to hours, you are completely pain free. God! What is this?
It sounds like you might have just had an attack of biliary colic or gallstone pain. Gall stones? Let's see what they are and why they cause so much trouble, who gets it, risk factors, how it is diagnosed and treatment options available.
The gallbladder is a pear shaped sac lying just under the right half of the liver.
It is where bile, that green bitter liquid we find in our vomit, is stored. It has a narrow part that joins the liver ducts and those of the pancreas, before they continue as a single drainage duct into the small intestine.
The liver produces about 500 to 1500mLs of bile every day. Some of this amount drains directly into the small intestines where it helps to emulsify or break down fat in our meals into water soluble material for easy digestion.
The remainder amount of bile is stored away in the gallbladder. The gallbladder concentrates the bile about ten times stronger than it was originally. If the bile gets over concentrated, crystals start to form in the solution, leading to stone formation.
This stone is what is referred to as gall stone.
Gall stones could be anything from the size of grains of sands up to tennis ball size. They could be only a few in some people to several hundreds lodged inside the gallbladder.
We have included a picture to the right of this paragraph, of a bottle filled with gallstones from one patient. He has been suffering with pain on his right upper abdomen for many months before a scan result identified his pain to be due to bilary colic or gallstones.
There are three types of gallstones. The type of gallstones you form will depend a lot on your diet.The three types of stones are:
In the United Kingdom and other affluent industrialized western countries, cholesterol stones are most prevalent. This is mainly because of high fat diet. In poor countries, pigment stones are more common.
Cholesterol stones, as the name suggests, contains cholesterol mainly. Pigment stones contain bilirubin salts (e.g. Calcium bilirubinate).
Up to 15 out of every 100 persons form stones in their gallbladder, and most times, these stones do not cause any problem. In the United States, over 20 million people have gallstones. 80 – 90 % of these are cholesterol stones. This situation is similar in other western countries. One in five women and one in eight men have gallbladder stones.
Women are twic emore likely to develop gallstones than men. If you eat fat rich food and diary products, you are also more likely to have gallstones.
The following are other risk factors for developing gallstones. They include:
Biliary colic or gallstone pain, gallstone sludge, cholecystitis, gallstone pancreatitis and gallstone ileus, are all a continuum in the spectrum of conditions referred to as gallstone or gall bladder diseases. Understanding how they relate would help in understanding the possible problems and complications that could arise from having gallstones.
Most gallstones in the gallbladder do not cause any problem.
In fact it is estimated that up to 80% of people who carry stones in their gallbladder do not know that they do and have no symptoms whatsoever.
Such stones are referred to as silent stones.
They may be accidentally picked up by ultrasound scan during investigation of the abdomen for other reasons. Such silent stones that are not causing any problem are better left alone.
stones from the gallbladder move into and block the tubes or collecting systems or ducts of the gallbladder
without an associated infection going on in the gallbladder, the
affected duct goes into spasm in an attempt to expel the stone. This
causes biliary colic as described above. This is due to gallstones alone.
If the stone irritates the wall of the
gallbladder, either because of its size, or from prolonged contact
and impaction for more than 6 hours, plus invasion by bacteria, this
could lead to the development of a disease of the gallbladder called Cholecystitis. This is gallstones plus gallbladder infection.
gallstones could also move to block the narrow passage way at the neck
of the gallbladder, or smaller stones could migrate out into the
collecting system of the liver or into the pancreatic ducts and small
intestines. Gallstones in the pancreatic duct will lead to gallstone pancreatitis. This is due to gallstones causing back flow or back up into the pancreas, leading to inflammation of the pancreas and severe central upper abdominal pain and vomiting.
When gallstones find their way into the small intestines, they could cause the small bowel from working in what is referred to as gallstone ileus.
Pus collecting in the gallbladder leads to gallbladder empyema. If not relieved, the gallbladder could rupture.
Prolonged irritation of the gallbladder could lead to cancer of the gallbladder.
typical story of biliary colic is one of sudden or insidious onset
right upper quadrant abdominal pain "from the blues". It may follow a
heavy meal or 1 to 2 hours after a fatty or fried meal. It could start and wake patient up at night. Any time.
One thing that differentiate biliary colic from cholecystitis, is that the pain usually resolve on time, and there is not an associated fever.
The pain may come back after a while, but patients usually feel well in between (during pain free periods).
There may be vomiting during the height of pain, and patient may try adopting various positions and rolling on the floor in a bid to alleviate the sufferings.
If the stone is successfully expelled from the duct where it is impacted, the pain may resolve and not come back on.
The diagnosis of biliary colic is mainly based on the story from the patient and examination findings.
The treatment options for bilary colic include:
In a small number of individuals, despite suffering with all the features of biliary colic, scans may demonstrate no stone in their gallbladder. If they nevertheless notice that consumption of fatty food triggers pain as described above, going on a low fat gallstone diet for gallstone sufferers may bring them relief.
Right upper abdominal pain? Think it might be due to biliary colic? Or have you been diagnosed with biliary colic in the past? Any great story or experience on this or related topic? Share it!
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