What are the causes of differential gallbladder pain (biliary colic)?

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Last updated: February 27, 2025 • View editorial policy

Differential Diagnosis for Gallbladder Pain

Single Most Likely Diagnosis

  • Cholecystitis: This is the most common cause of gallbladder pain, typically presenting with right upper quadrant pain, fever, and leukocytosis. The pain often follows a fatty meal and can radiate to the right shoulder.

Other Likely Diagnoses

  • Cholelithiasis (Gallstones): Gallstones are a common cause of gallbladder pain, often presenting with intermittent right upper quadrant pain, especially after eating fatty foods.
  • Biliary Dyskinesia: A motility disorder of the gallbladder, which can cause chronic or recurrent right upper quadrant pain, often without evidence of gallstones.
  • Peptic Ulcer Disease: Although not directly related to the gallbladder, peptic ulcers can cause similar pain patterns, including right upper quadrant pain, especially if the ulcer is located in the duodenum.

Do Not Miss Diagnoses

  • Acute Pancreatitis: A serious condition that can present with severe abdominal pain, often radiating to the back, and can be life-threatening if not promptly diagnosed and treated.
  • Myocardial Infarction: Although less common, myocardial infarction can present with atypical chest pain or referred pain to the right upper quadrant, making it a critical diagnosis not to miss.
  • Pneumonia (Right Lower Lobe): Right lower lobe pneumonia can cause referred pain to the right upper quadrant due to the proximity of the diaphragm and can be a life-threatening condition if not treated promptly.
  • Hepatic Abscess or Liver Cyst: Infections or cysts in the liver can cause right upper quadrant pain and can be serious if not diagnosed and treated properly.

Rare Diagnoses

  • Sphincter of Oddi Dysfunction: A rare condition affecting the sphincter that regulates bile flow, causing recurrent biliary-type pain.
  • Gallbladder Cancer: A rare malignancy of the gallbladder, often presenting with non-specific symptoms, including right upper quadrant pain, weight loss, and jaundice.
  • Porcelain Gallbladder: A rare condition where the gallbladder wall becomes calcified, which can increase the risk of gallbladder cancer and cause chronic right upper quadrant pain.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.