Hey, what’s up, you guys?
My name is Buck Parker. I’m a board certified general surgeon. In this video, we’re gonna talk about gallbladder symptoms, gallbladder disease symptoms. In the last video, we talked about the anatomy of the gallbladder and the physiology of the gallbladder and why we develop problems with the gallbladder. This one, I’m gonna specifically talk about the symptoms of a gallbladder disease and why we have those symptoms and actually why it’s hard to distinguish from other organs and other problems and what the diagnostic dilemma ends up being and why that is.
First, we’ll start with a little anatomy. We did this in the last one, but you haven’t watched that. Go back and watch it if not. We’ll go over this real quick again. This is the esophagus, stomach, liver. And the liver, this is the left side, this is the right side. This is the gallbladder, GB. This is the small bowel. We’ll just put small bowel. That’s the duodenum. And this is the pancreas here. These are called the bile ducts. This is the common bile ducts, and we’ll say CBD.
We talked about what happens in gallbladder disease in the last video. In this one, I wanna talk about what are the symptoms specifically. Before we talk about that, I wanna just mention real quickly. We have this nerve, it’s called the vagus nerve. It’s V-A-G-U-S. It’s not Vegas like (imitating EDM music). It’s V-A-G-U-S, the vagus nerve. This is one of the main autonomic nerves, which means it runs everything in the background of our body. It comes from our head, and it goes in through our neck actually really, really close to the esophagus here. It’s got a anterior and posterior branch, which means front and back branch and then it flips around to right side and left side. So essentially, the vagus nerve comes in. The nerve innervates the stomach, the pancreas, then goes over here to the liver. It travels down here, and it has these little branches. It innervates, essentially, all of this here. The first part of the duodenum and the pancreas and the bile ducts and the liver and the esophagus and the stomach. All these things are innervated by the vagus nerve. What ends up happening is with many of the diseases of this portion of the body we call the foregut, this will have similar symptoms. They’re not all exactly the same, but they are definitely similar and they’re perceived in a similar spot.
Typically, let me draw this little picture here, get this out of the way. If we go like this, this is the belly button, this is the ribcage, this is the groin crease in the belly. This is the left, this is the right. Typically, this is called, we would call this the epigastric area. Epigastric. This is the right upper quadrant. Right upper quadrant. This is the left upper quadrant. Left upper quadrant. Well, it’s kind of like this I suppose honestly. This is the right upper quadrant, this is the left upper quadrant. This is the right lower quadrant, this is the left lower quadrant. Many of these symptoms are going to be in this area, this band area right here for these organs. But we are on the right side and more often than not, we have right upper quadrant symptoms. But some patients, for whatever reason, only develop this epigastric pain. They come in and they have, they go oh man, right here. It just hurts right here. After a meal, I get this crampy, bad pain right here. I got fevers and chills and all this stuff. You think well, that’s really maybe gonna be esophagus or stomach because that’s more midline but it ends up being their gallbladder, which is over here which is a kind of interesting thing. But that’s because the referred pain from this vagus nerve.
Most of the pain you’re gonna have is in the right upper quadrant. People develop crampy pain. What happens is – we talked a little bit about this in the other video – their gall stones get stuck in the neck here or here or here and that gallbladder is trying to squeeze against an obstruction. When it’s squeezing and it can’t push anything, that’s when you develop this crampy right upper quadrant pain and people come in and they go, oh man, I just have this crampy pain right up here. They grab their upper abdomen, lower chest and say, it’s just right there. It’s so bad. It’s just cramps. And then they say, well I had it a couple of times last week then it went away. I thought I was fine. Then this time it came back and it never went away.
Typically, they’ll have it for a couple of hours and then it completely goes away. Then they come back a week later. Now they got fevers, chills, nausea, vomiting maybe, and they have this right upper quadrant pain, and it’s more of a dull, achy pain this time and that’s not going away.
The other thing I wanna talk about is because of the nerves, the nerve to the diaphragm. The nerve to the diaphragm also comes down through the chest. It comes down through the neck and lays on the back of the chest. We get this back pain. Some people say, I have this right upper quadrant pain and this back pain here. I don’t know why I have – shoulder blade, I should actually say, shoulder blade. I have a shoulder blade pain, and it’s uncomfortable. I keep doing this like it’s gonna go away, but it’s not because it’s actually the gallbladder laying on a diaphragm. The diaphragm is innervated by this nerve. It comes down through the chest, innervates also around the scapula in the shoulder blade. That’s why they get this different pain, which is interesting.
The other thing that typically happens is when we have a stretch, or the stomach is really stretched out, and it can’t empty or the small bowel is blocked somewhere and it can’t empty and it’s trying to squeeze against that, we get this nausea. Because, basically, the body is saying hey, you can’t get anything- nothing’s going forward, it’s gotta come back up. The same pain here, the same symptoms end up happening. You get this nausea because the gallbladder can’t push through so it’s telling the body hey, nothing’s going forward. We gotta go back the other way. So you have this nausea, vomiting.
The other thing that happens is gallbladder symptoms are on a continuum. We have what we call, biliary colic, and that’s the pain where you develop this crampy pain and it completely goes away. And then it goes…on a continuum, we can go either way to acute, what we call acute cholecystitis, or acute infection of the gallbladder. In the middle, is chronic cholecystitis. This is a biliary colic happening over and over and over so the gallbladder becomes inflamed, but it doesn’t become infected. Acute cholecystitis, we call it infected. We even get to gangrenous because sometimes the gallbladder completely dies. When we go in there, it’s completely dead or part of the wall is starting to become dead so we call it gangrenous. That’s when the gallbladder is actually starting to die.
In relation to that, what happens is you get fevers because you start to develop an infection. If you have fevers, chills at home and then you get this nausea, vomiting, right upper quadrant pain, maybe some back or shoulder pain or shoulder blade pain, then that is the classic symptoms of gallbladder disease. That’s all because these stupid little stones here are blocking everything off. After a while, this thing can get infected because the bacteria there is…There are bacteria in the small bowel here, which can go backwards through the bile duct and get into the gallbladder because stasis is the problem. If nothing’s moving out so the bacteria can get in there and they’re not flushed out good enough, they can start to proliferate. Eating up the gallbladder, basically the wall, to get infected and all this stuff.
That’s the quick and dirty on gallbladder symptoms and gallbladder disease symptoms, so I hope you understand that. It gives you a better understanding of what’s going on if you had it or you’re having it or maybe you need to go see a doctor and you weren’t sure yet. If you have these things, you got fevers, chills, nausea, vomiting, right upper quadrant pain, cramping maybe to the back, then maybe it’s time to go see your doctor ASAP.
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