The Usual & Unusual Gallbladder symptoms: Gastroenterologist explains.

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What you need to Know: The usual gallbladder symptom is biliary colic. Biliary colic is an intense, constant right-upper quadrant pain. The pain often spreads to the epigastric area and the back. It is associated with nausea and vomiting, and it lasts from 30 minutes up to 6 hours. Unusual gallbladder symptoms include:

Isolated nausea after eating.
Early satiety.
Sense of fullness after eating.
Chest pain.
Heartburn.
Isolated epigastric pain.
Bleching.
Bloating and abdominal distension.
Symptoms of complications such as fever, severe tenderness over your abdomen, jaundice, clay stool, and others.

We will dive deep into the usual and unusual symptoms of gallbladder disease.

The usual gallbladder symptoms:

The gallbladder can be affected by many diseases and conditions. However, the most common gallbladder condition is gallstones, which will be our focus today. A gallstone can affect you in 3 ways.

Asymptomatic: many people discover gallstones by accident during routine abdominal ultrasonography or radiography.
Uncomplicated gallstone disease: is isolated attacks of biliary colics, without complications. Biliary colic is the most common gallbladder symptom.
Complicated gallstones disease: Less common, occurs when gallstones start to cause complications such as:

Acute cholecystitis: acute inflammation of the gallbladder.
Obstructive jaundice: typically presents with jaundice, and clay stool due to impaction of a stone in the bile duct.
Cholangitis: the inflammation of the biliary ducts.
Gallstone pancreatitis: is an acute inflammation of the pancreas due to the obstruction of its duct by a slipped gallstone.
Gallstone ileus is intestinal obstruction by the impaction of a gall stone in the ileum (part of the small intestine). It is a rare complication, more in older patients.

The typical gallbladder symptom (biliary colic) is characterized by:

The Term (colic) is inaccurate because the biliary colic is often constant, not colicy.
Trigger: the pain often is triggered by eating a large fatty meal. However, it can start spontaneously.
NOT triggered by movement, and it is not relieved by bowel movement or passage of flatus.
The character of pain: is intense, dull ache. It increases in intensity gradually and may reach extreme levels (some describe the biliary colic as worse than labor pain.
Site: Classically, you feel the pain in the right upper quadrant below the rib cage. It commonly spreads to the upper-middle stomach area (epigastrium) and the back (the right shoulder blade).
Duration of the attack: The pain increases gradually, lasting at least 30 minutes. Often it reaches its maximum intensity and plateaus within an hour; then, it slowly resolves. It can last for up to 6 hours.
Recurrence is often the rule. But the timing of recurrence of biliary colic is highly variable. You may experience recurrent biliary colic within a few hours, and it may disappear for years.
Commonly associated symptoms: Nausea after eating, vomiting, excessive sweating during the attack.

Signs indicating it’s not a usual biliary colic (complicated gallbladder disease): When the biliary colic:

It lasts for more than 6 hours: it is often an indication of complicated gallbladder disease. The two most common complications are acute cholecystitis and bile outflow obstruction.
Associated with: fever, general ill-looking with biliary colic indicates acute cholecystitis.
Associated with: yellowish discoloration of your skin, eye whites, dark urine, and pale stool are signs of an impacted stone obstructing the bile outflow.

MORE: Gangrenous Gallbladder (Simplified): Causes, Symptoms, Mortality Rate, & Treatment.

The below table summarizes the usual gallbladder pain (biliary colic) characters:

Biliary colic (Uncomplicated gallstone).	Description
1. Site	Usually, The right upper quadrant of your abdomen
2. Spread	– The pain may spread to the back of the right shoulder. – Also, it spreads to the epigastric area.
3. Character	Constant builds up then disappeared gradually.
4. Duration	At least 30 minutes. It may last up to 6 hours.
5. Relation to food	– Triggered by foods (especially fatty food and large meals. – However, it can start spontaneously.
6. NOT related to:	Movement, bowel movements, or the passage of flatus.
7. Nausea	Often Present, severe.
8- Commonly associated symptoms	Vomiting, sweating during the attack.
6. Unusual symptoms.	– Heartburn and chest pain. – Bloating, fullness. – Early satiety. – Isolated epigastric pain.
6. Symptoms NOT associated:	– Fever. – Jaundice. – Prolonged pain for more than 6 hours. – Extreme tenderness over the gallbladder (Murphy’s sign). – Vomiting of blood, blackish stool (PUD).

The unusual (atypical) symptoms of Gallbladder disease:

1. Isolated nausea after eating.

Nausea is frequent with almost all gut-related diseases and conditions such as:

Gastroesophageal reflux disease (chronic reflux).
Chronic gastritis.
Peptic ulcer disease.
Acute gastroenteritis (as stomach flu).
Functional dyspepsia.

What is unique about gallbladder disease is intense nausea after eating. As a gastroenterologist, I always suspected gallstones when my patients report extreme nausea after eating. Also, chronic or symptomatic gallbladder disease may present with isolated nausea. The nausea is almost exclusively after eating (particularly fatty foods). Most of the time, the nausea is disproportionately severe compared to the pain. Consult your doctor if you have a sense of impending vomiting after eating fatty food. Nausea can be a sign of something in your gallbladder. Post-prandial nausea with gallbladder diseases is common. However, we enlisted it in the list of (unusual) symptoms because:

It can be the main sign of mild gallbladder disease (as silent gallstone).
It is often attributed to the stomach or esophageal diseases. You may overlook nausea as a sign of gallbladder disease. Also, some doctors may ignore this sign.

2. Fullness after eating/early satiety.

Being unable to complete your meal (early satiety) or feeling full after eating are unusual symptoms of gallstone disease. Most of us attribute early satiety and fullness to indigestion or functional dyspepsia. However, the two symptoms can be a presentation of gallbladder disease, especially if you have risk factors for gallstones such as:

obesity.
Being a female.
History of rapid loss of weight.
Fatty or junk food.
Positive family history of gallstones.
The risk increases with age.

Asymptomatic gallstones are common. Asymptomatic gallstones are found in (reference):

5% of females aged 20-29 years.
9% of females aged 30-39 years.
11% of females aged 40 years or more.
Gallstones are rare in males aged less than 40 years. But its risk increases with age.

Early satiety and a sense of fullness can be unusual symptoms of silent gallstones.

3. Abdominal bloating, bleching, and regurgitation.

Distension, bloating, bleching (eructation), and regurgitation are unusual for gallbladder stones. Bloating, bleching, and regurgitation are expected with GERD and food intolerance.

However, they’re reported among the unusual (atypical) symptoms of gallbladder diseases.

4. Upper middle stomach (epigastric pain).

The typical biliary colic is in the right upper quadrant and spreads to the back and epigastric area. However, you may experience upper middle stomach pain (epigastric pain) without upper-right pain. Although unusual, a significant subset can present with such symptoms.

Doctors and patients often attribute epigastric pain to stomach conditions such as gastritis, h. pylori infection, and peptic ulcer disease.

This unusual gallbladder pain location may lead to a misdiagnosis. Consult your doctor if your stomach medications are not working.

5. Chest pain and heartburn.

Gallbladder diseases may cause chest pain. The pain is often of a moderate intestine and is frequently recurrent. Gallstone sufferers may report chest pain on the upper right side over the ribs or under them. Also, the pain may affect the front of the chest. Heartburn is the main symptom of acid reflux.

In addition, heartburn is reported as an atypical (unusual) symptom of gallbladder diseases. The unusual symptoms such as chest pain, heartburn, bloating, belching, and regurgitation may not reflect gallbladder disease.

Instead, they may represent just an association rather than a result of gallbladder disease. In addition, many of the unusual gallbladder symptoms don’t improve after removing the gallbladder (reference).

6. Intestinal obstruction (gallstone ileus).

A single gallstone (or a group of gallstones) may obstruct the last part of the small intestine. This type of intestinal obstruction is called gallstone ileus. It is common in debilitated older adults. However, the gallstone ileus is unusual in a healthy, young individual.

Symptoms include: