Gallbladder is a small pear shaped sac which is situated right behind the bottom of the liver. It works as a storehouse for the bile, the digestive juice produced by the liver. Absorption of water, minerals and salts from the bile makes it concentrated before it is passed on to the duodenum by the gallbladder. Bile plays an important role in emulsification of ingested fat, in the intestine.
The condition wherein pain in the upper right quadrant (gallbladder area) of the abdomen is experienced again and again, in the absence of gallstones, is referred to as biliary dyskinesia. It is also known as acalculous gallbladder disease.
Biliary Dyskinesia Causes
Function of the gallbladder is to store and empty the bile into the duodenum. Bile is stored in the gallbladder in between the meals and it is concentrated. Ingestion of food triggers contraction of gallbladder. If gallbladder fails to contract properly, it cannot pass its contents to the duodenum. Impaired function or improper emptying of the gallbladder leads to excessive pressure in the gallbladder and the bile duct, resulting in pain. 'Dyskinesia' literally means 'abnormal motion'.
Excessive stress can lead to impaired function of the gallbladder. Chronic inflammation of the gallbladder can affect its function significantly. Following a low fat or no fat diet or low fiber diet can affect the gallbladder function. Various thyroid disorders, obesity, low stomach acid, alcohol abuse, excessive consumption of refined foods and sugars, excessive consumption of anti-acids and antidepressants, diabetes, chronic inflammatory bowel disease, etc., are all considered as risk factors for gallbladder diseases.
Biliary Dyskinesia Symptoms
Abnormal gallbladder function leads to right upper quadrant abdominal pain. The pain may spread to the upper back. Sometimes the pain can radiate to shoulder blades as well. Ingestion of food usually triggers the symptoms. The person may experience severe abdominal pain after eating fat rich foods. Fried foods or heavy meals may worsen the situation. The person may suffer from nausea, vomiting, bloating, burping or belching as fats are not digested properly.
Lack of sufficient bile in the intestine may even lead to indigestion and loose stools. Some people may complain about vague cramping while some may experience sharp recurring pain. The patient may not be able to identify the exact location of the pain, while experiencing dull ache beneath the right rib cage. The person may complain about a vague discomfort in this region.
If gallbladder is causing the pain, then the pain is generally experienced about 40-50 minutes after the consumption of a meal rich in fat. The abnormal contraction of gallbladder can be sometimes even asymptomatic. But usually, the symptoms of biliary dyskinesia, gallbladder disease symptoms (when gallstones are formed) and pancreatitis symptoms are similar.
Biliary Dyskinesia Diagnosis
When patient complains of episodic pain in the upper right abdomen, doctors usually order an ultrasound test. When no gallstones are found in the image, and when the chances of pancreatitis or cancer are ruled out, doctors order CCK-HIDA (cholecystokinin dimethyl iminodiacetic acid) scan. Certain radioactive substance (low strength) is mixed in the collected blood sample of the patient and the blood is again injected into the body of the patient. Then, the hormone cholecystokinin octapeptide (CCK) is given to the patient.
The hormone CCK triggers gallbladder contraction. A special camera captures the images of emptying of gallbladder into the duodenum. The radioactive substance passed into the body helps get clear images. Doctors can thus determine whether the gallbladder is functioning well or not. If the images show impaired function, diagnosis of functional gallbladder disease is confirmed.
Doctors suggest to follow a biliary dyskinesia diet (very low fat diet) to prevent pain and digestion problems. In most cases, cholecystectomy (surgical removal of the gallbladder) helps relieve the symptoms. Like gallstone diseases, percentage of women suffering from biliary dyskinesia is much higher than the percentage of men suffering from the same. If one experiences recurring cramp-like pain or persistent dull pain just beneath the right bottom rib, one should immediately consult a doctor.