This occurs when stones passed out of the gallbladder lodge in the hepatic and common bile ducts, obstructing the flow of bile into the duodenum. The pain associated with choledocholithiasis is related to the pressure created when these stones lodge in the common bile duct. The greater the pressure, the greater the pain. The prognosis is good unless infection occurs. Cholecystitis, acute or chronic inflammation of the gallbladder, is usually associated with a gallstone impacted in cystic duct, causing painful distention of the gallbladder or visceral pain.
Visceral pain is very difficult to treat due to the defuse of the pain.
Analgesics can be effective after the pain localizes. The acute form is most common during middle age, whereas the chronic form is more common with the elderly. Prognosis is good with treatment. Pain may range from vague discomfort to abrupt onset of pain with epigastric distress. It begins with acute abdominal pain in the upper right quadrant, may radiate to the back, between the shoulders, or to the front of the chest.