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Cholecystitis, or inflammation of the gallbladder is notoriously difficult to diagnose. Especially in children, the elderly, and diabetics, the symptoms of gallbladder disease tend to be vague. You might have a fever. That's not the sort of thing you would immediately associate with gallstones. You might have a pain in your right leg. You would think "How did I hurt my leg?" before you would stop and consider gallbladder disease, and your doctor would, too. 

Some of the symptoms of gallbladder disease occur in some cases but not in others. Cholecystitis (inflammation of the gallbladder) and cholelithiasis (gallstones) can cause jaundice, yellowing of the skin and the whites of the eyes, but 85 percent of the time they don't. Doctors can look for the Murphy sign (tenderness over the gallbladder and a slight gasp when the area is palpated) but 60 to 70 percent of the time the test for the Murphy sign is negative. And sometimes the pain is so "spread out" that the gallbladder is far down the list of places to look.

On the other hand, even when you "just know" you have gallbladder trouble, some of the same symptoms can be caused by other conditions:

  • Sometimes the problem isn't in the gallbladder. It's in the bile duct connecting the gallbladder to the liver. Similar symptoms are caused by biliary colic (spasms of the bile duct), cholangitis (inflammation of the bile duct), or tumors of the bile duct.
  • Deficient circulation caused by mesenteric ischemia can cause intense pain in the general region of the gallbladder. If you are physically active, sometimes getting dehydrated can set off a bout with this problem. If you are elderly, sometimes atherosclerosis of the mesenteric arteries is the culprit.
  • Sometimes the gallbladder fills up with clear mucus. Gallbladder mucocele usually presents a large mass that the doctor can feel during exam. This mass follows gravity and extends downward from the liver.
  • KIdney infections (pyelonephritis) can cause acute pain in the general vicinity of the gallbladder. Usually kidney infections cause vomiting and fever along with pain, although not necessarily on the same day.
  • Peptic ulcers cause pain in the same general area as the gallbladder, but this pain will be worst two or three hours after meals. Sudden, sharp pain may be a sign that the ulcers have perforated and emergency surgery may be needed. What can happen with peptic ulcers that usually doesn't happen with gallbladder problems includes progressively worse pain during eating, feeling full fast, and blood coming up or found in stool. See your doctor right away if you have these symptoms.

Ultrasound, CT scans, and magnetic resonance imaging (MRI) are good for visualizing the soft tissues in and around the gallbladder and for locating stones. If the wall of the gallbladder has thickened, or there is an accumulation of gas, or there is a kind of "sludge" in your gallbladder, then there is a good chance that you have cholecystitis. However, the only way to know for certain what's in your gallbladder is for a surgeon to take a look. If there is indication of gallbladder disease, however slight, it will almost certainly be removed as long as the surgeon has you in the OR. It's possible to get gallstones, by the way, even after your gallbladder has been removed, and it's possible to have gallbladder inflammation without stones.

Don't try work with a doctor who does not take you seriously. On the other hand, make sure your doctor has all the information needed to make a correct diagnosis. When you have what you think is gallbladder pain, make a pen and paper or computerized note of what you ate just before the attack, all your symptoms during the attack (including how full you felt, whether you had gas, where the pain was focused or where it seemed to go), how long the pain lasted. If a certain body position made the pain better or worse, let your doctor know. It can take more than one try to get gallbladder disease diagnosed, but when you do, there is usually a cure.



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