Now, if things don't flow well, remember this picture?
Look at those gallstones.
They look kinda harmless when they're in the gallbladder,
but look, you've got a gallstone in the neck, right?
In the cystic duct. You've also got one in the common bile duct.
So, what happens in my body when things don't flow well?
Well, if you continue to trace that common bile duct down,
you'll see that oh, my, there is a stone right there pretty close to the pancreas.
So, it does matter, the placement of the stones
because when I have a stone blocking the flow, I've got an obstruction.
This is why somebody with gallstone disease, cholelithiasis,
depending on where that stone is stuck, you're gonna have problems upstream.
So, that went all the way down at the bottom.
It's gonna give me problems with my pancreas.
Inflammation of my pancreas or pancreatitis.
I'm also gonna end up with cholecystitis because it's gonna be blocking things upstream,
the gallbladders upstream, and what if you keep tracing that duct,
what's at the very top? Right, your liver.
So, I can also have a hepatitis not caused by a virus,
but caused by the backup is bile because when things don't flow well,
everything upstream is gonna have a problem.
So, what if it ends up in a duct? Well, I always call that stuck ducts.
Right, we just talked about that stone that's way down there at the bottom in the pancreas
and how it can wreak havoc all the way back up,
but obstructions are most commonly caused by stones.
You can have them for other reasons,
but if a person has an obstruction in their bile duct, it's usually because of a gallstone.
It just depends on how far it travels.
Now, I said obstructions or stones are the most common,
but there's some other things that can cause it too.
If those ducts get inflamed, they can kind of be swollen closed.
Patients could experience trauma, biliary stricture, cyst, enlarged lymph nodes, pancreatitis,
or some other type of injury during gallbladder or liver surgery.
So, since that is all in such a small tight space,
when one of these organs that are connected to the hepatobiliary system have problems,
they can share those problems with the other organs associated with the hepatobiliary system.
So, let's say we got this. We got stuck ducts. What does that lead to?
What am I likely to see in a patient who has stones stuck in their ducts?
Yeah, that's a pretty good picture.
Biliary colic, this can be very uncomfortable for your patient.
So, we made a wanted poster for you, right?
Biliary colic is also known as a gallbladder attack.
This means stones or sludge have moved to the point where they are obstructing the flow of bile.
Now, do you think everyone who has gallstones feels like they're going to die?
Well, you might think like, that is a silly question.
No, I promise you. I've been in ER when someone comes in
and they swear they are going to die or having heart attack and really,
we find out through differential diagnosis that what they're having is a gallbladder attack.
They're not exaggerating. It is excruciatingly painful and sometimes,
it can mimic the same symptoms as an MI,
but not everyone who has gallstones feel like they're going to die.
In fact, according to the American College of Gastroenterology,
80% of people have silent gallstones. It will never have those symptoms.
So, no. Everyone who has gallstones does not feel like they're gonna die
and a large percentage of people don't even know they have them.
Now, gallstones are often found in ultrasound or an X-ray of the abdomen
that they did for another reason besides someone complaining of gallbladder attacks.
Let's zero in on the other 20%, the people that do experience biliary colic.
Now, this type of pain can be excruciating for patients.
I promise you, they are not exaggerating. Here's why it hurts so much.
You see that gallbladder? We've got that red around where that stone is.
See, the gallbladder contracts vigorously against that blockage.
That's what causes the severe pain. They have these spasms.
Sometimes it's even a constant pain, sometimes it comes in waves,
but it's usually excruciating when it's reached this point.
So, biliary colic is caused by these severe spasms of the duct.
When that gallstone gets stuck or that it's moving through the system, it can be very painful.
Much like people when a kidney stone is moving through their urinary tract,
it's painful, same thing with a gallstone.
As it's moving through that hepatobiliary system,
you can end up having excruciating spasms and additional pain.
Make sure the patient recognizes the symptoms of gallbladder attack or pain.
That biliary colic is the severe spasm in the bile ducts
when it's blocked by a stone or inflammation.
Ouch. Let's talk about pain, one of the main symptoms of a gallbladder attack.
Pain in the upper right side or the middle of the abdomen is fairly common.
So, when you look at our graphic and our drawing there,
you see the big red spots where a patient is likely to report pain.
Now, the pain can be dull or it can be sharp,
it's really all over the map when it comes to individual patients.
It usually has an abrupt onset and it's constant, lasting 15 minutes all the way up to 4-5 hours.
Now, the pain is usually steady and it may spread to the back.
Look in the area where we have that highlighted for you.
So, it may spread to the back or to an area below the right shoulder blade.