This term covers heartburn (a central chest discomfort) and upper abdominal discomfort or pain. Possible causes include reflux, ulcers and functional dyspepsia - even sometimes irritable bowel syndrome...


Gallstone has logged in the duct connecting the gallbaldder to the main bile duct. This is cause severe pain known as biliary colic



Background information

    • About 15% of people in New Zealand will develop gallstones over a lifetime.


    • They are more common in;
      • Women.
      • People who are overweight.
      • Family history of gallstones.


    • There are several different types of gallstones.
      • Most stones are formed from a supersaturated solution of cholesterol in the gallbladder.
      • Only 10% of gallstones will show on a plain X-ray.
      • Most gallstones are picked up on abdominal ultrasound.


  • Most stones start as a small cholesterol crystal.
    • The crystal slowly grows depending on the saturation of bile salts and cholesterol in the bile.
    • The function of the gallbladder may be important.  Failure to empty normally could an important factor.
  • Pigment stones (10% of all gallstones).
    • These occur because of increased breakdown of blood.



Biliary colic – gallstone pain.

    • Stones in the gallbladder may cause abdominal pain - this is called biliary colic.
      • This pain is usually an “attack” with sudden onset and lasts for 4-6hours.
      • The pain is mainly in the right upper abdomen but can also be in the lower chest and back (over the right shoulder blade).
      • There is often nausea and/or vomiting.  You may appear to be pale and have excess sweating
      • The severity of the pain is often enough to want to seek out urgent medical attention.
      • Sometimes the pain is confused for a heart attack.
      • There can be repeated episodes of pain but not usually daily episodes.


    • Biliary colic is caused by a stone lodging in the outlet of the gallbladder.
      • Most of the time the stone falls back into the gallbladder and the “attack” is over.
      • Biliary colic may be brought on by a large fatty meal because this causes strong contractions of gallbladder.


    • If the pain lasts for more than 6 hours then a complication may have arisen.
      • The main potential complication is inflammation of the gallbladder.  This is called acute cholecystitis.  Hospital admission is essential.
      • Another complication is migration of a stone to the main bile duct. This leads to jaundice;  often infection (cholangitis) or pancreatitis.


  • Treatment involves
    • Intravenous fluids, pain relief, antibiotics.
    • Then proceeding to cholecystectomy (removal of the gallbladder) – usually during the same hospital admission.
    • Sometimes there is a preference for waiting for the inflammation to settle down before proceeding to surgery.




Gallstones on ultrasound but no pain.


    • This is a common situation. Ultrasound of the abdomen is a common investigation that is done for a wide variety of reasons.
    • Many gallstones that are picked up on ultrasound will be causing no symptoms.
      • 60 - 80% of all gallstones cause no problems.
      • About 20% of people with gallstones picked up by chance will develop symptoms due to the gallstones over the next 20 years.
      • Therefore most people would think that watching and waiting is the best response rather than an operation.






Gallstone type of pain but no gallstones

    • This is also a common situation. Pain in the right upper abdomen may be similar to gallstone pain (biliary colic) but no stones are found when the ultrasound is done.


    • The most likely explanation is that the pain does not arise from the gallbladder but from the colon or from the stomach.
      • Pain from the colon is due to irritable bowel syndrome.  Pain with IBS can occur anywhere in the abdomen.
      • Sometimes constipation leads to distension of the colon on the right side of the abdomen and right-sided abdominal pain.
      • A gastroscopy should be performed to check for peptic ulcer or acid reflux.
      • A trial of medical therapy and/or dietary manipulation focused on IBS as a possible diagnosis may be considered first.  Patients with IBS are 7 times more likely to have had a cholecystectomy  - this strongly suggests that cholecystectomy has been inappropriate for many of these patients.
  • There is a debate as to whether the gallbladder can give rise to pain in the absence of gallstones.
    • There is some suggestion that a “non-functioning gallbladder” is associated with episodes of pain.
    • This means that the gallbladder does not take up the bile coming down from the liver.
    • This “non-functioning” state can be detected by a radionuclear scan called a HIDA scan.
    • A scan showing a “non-functioning” gallbladder predicts a reasonable success rate with cholecystectomy (perhaps 2/3 will have symptom relief).




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