Abdominal pain, felt anywhere between the chest and groin, affects almost everyone at some point in their lives. Your abdominal region contains many different organs, including the liver, pancreas, gallbladder, kidneys, appendix and spleen, making diagnosis of abdominal pain difficult. Gallbladder stones, the formation of hardened stone-like material consisting of either bilirubin or cholesterol, cause steady pain in the upper right abdominal region. To provide an accurate diagnosis, doctors utilize ultrasound techniques and blood tests because different types of stones in different locations can cause an elevated level of different liver enzymes.
Causes
Your gallbladder, a sac located below the liver, receives bile from the liver, stores it and releases it into the cyst duct that leads to the common bile duct when needed for digestion. Bile, a substance consisting of water, cholesterol, fat, bile salts, proteins and bilirubin, breaks down fat in the small intestine. Too much cholesterol in the bile promotes the formation of cholesterol stones, which account for 80 percent of all gallstones, according to the National Digestive Diseases Information Clearinghouse. Bilirubin gallstones may form due to an overproduction of bilirubin, a waste product produced during the breakdown of old red blood cells, the buildup of scar tissue in the liver or an infection in the ducts leading to and from the gallbladder. Your doctors can determine the level of each liver enzyme to help determine the type and location of your gallstones.
Liver Enzymes
Doctors can monitor liver function through the levels of four main enzymes; aspartate aminotransferase, AST; alanine aminotransferase, ALT; alkaline phosphatase, AP; and gamma-glutamyl transferase, GGT. Elevations in these liver enzymes may indicate the presence of liver inflammation or disease but can also help doctors provide an accurate diagnosis for gallbladder stones.
Gallstone Pancreatitis
The gallbladder and pancreas are connected through the common bile duct. Pancreatitis is inflammation of the pancreas that causes acute abdominal pain, nausea, vomiting and fever. These symptoms resemble the symptoms of gallbladder stones, but pancreatitis can lead to life-threatening complications. The presence of gallstones can cause pancreatitis; in fact, approximately 40 percent of pancreatitis cases are associated with gallstones, according to the University of Maryland Medical Center. Blood tests help diagnose gallstone pancreatitis because elevated levels of pancreatic enzymes along with elevated levels of the liver enzyme ALT are specific for this type of gallstone.
Common Bile Duct Stones
Gallstones form in the gallbladder but can enter the cyst duct or the common bile duct and cause an obstruction. An obstruction in one of these ducts inhibits the flow of bile from the gallbladder and can cause gallbladder inflammation. The common bile duct also connects to the liver; thus, a gallstone obstructing this duct can also affect liver function. Laboratory tests can reveal a common bile duct gallstone obstruction with moderately increased levels of the liver enzymes AST and ALT and levels of AP greater than four times the normal level.
References
- National Digestive Diseases Information Clearinghouse (NDDIC): Gallstones
- "University of Maryland Medical Center"; Gallstones and gallbladder disease - Diagnosis; Harvey Simon, MD; June 2009
- "MedlinePlus"; Abdominal Pain; D. Zieve; October 2009
- Lab Tests Online: Liver Panel
- National Digestive Diseases Information Clearinghouse (NDDIC): Pancreatitis
