From the Guidelines
Pain from the gallbladder is typically referred to the right upper quadrant of the abdomen. This is based on the most recent and relevant evidence from the field of diagnostic imaging for acute abdominal pain in adults 1.
Key Points to Consider
- The location of referred pain from the gallbladder is crucial for diagnosing conditions like cholecystitis or cholelithiasis.
- The right upper quadrant pain is often accompanied by pain in the right shoulder and between the shoulder blades due to shared nerve pathways through the phrenic nerve.
- The pain pattern can be exacerbated by eating fatty meals, which stimulates gallbladder contraction.
Diagnostic Considerations
- Ultrasonography is recommended as the initial imaging test for patients presenting with right upper quadrant pain, as it is more readily available and does not expose the patient to ionizing radiation 1.
- Other imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) may be considered in patients with inconclusive ultrasonography results or to help guide surgical planning.
Clinical Implications
- Understanding the referred pain patterns from the gallbladder is essential for accurate diagnosis and treatment of gallbladder conditions.
- A thorough history, physical examination, and laboratory testing are often insufficient for diagnosing acute cholecystitis without further workup, highlighting the importance of imaging studies like ultrasonography 1.
From the Research
Referred Pain from the Gallbladder
The location of referred pain from the gallbladder is typically in the right upper quadrant of the abdomen. Some key points to consider include:
- The gallbladder is a source of common disease processes with a wide variety of presentations, including acute or chronic cholecystitis, adenomyomatosis, cancer, polyps, and postoperative complications 2.
- Ultrasound is the imaging modality of choice for the initial evaluation of patients who present with right upper quadrant pain, which can be referred from the gallbladder 3.
- The American College of Radiology appropriateness criteria for the imaging evaluation of patients with right upper quadrant pain and the Tokyo Guidelines for evaluating patients with acute cholecystitis and acute cholangitis are presented in the literature 4.
- Referred pain from the gallbladder can also be associated with other complications, such as choledocholithiasis, gallstone pancreatitis, acute cholangitis, Mirizzi syndrome, cholecystobiliary and cholecystoenteric fistulas, and gallstone ileus 5.
- The sensitivity of ultrasound for diagnosing cholecystitis, which can cause referred pain, has been found to be lower than previously reported, at 75.7% for acute cholecystitis, 34.6% for chronic cholecystitis, and 42.7% overall 6.