The Concept of Physiologic Dysfunction of the Gallbladder

Abstract

A patient admitted with abdominal pain requires careful questioning, a thorough examination, and indicated laboratory tests. All surgeons are familiar with the patient who is admitted with postprandial upper abdominal colicky pain, some degree of fatty food intolerance, nausea, and flatulence, but whose oral cholecystogram is "within normal limits." It is becoming increasingly apparent that the symptoms described above may be associated with motor dysfunction of the gallbladder, originally termed "biliary dyskinesia" by Westphal in 1923. In the early years of this century, prior to the advent of oral cholecystography, the gallbladder was removed in many patients who had the "classical" symptoms of upper abdominal colicky pain associated with fatty food intolerance, flatulence, and occasional nausea. Additional factors, such as constipation, headache, or being female, fat, and fertile, simply made cholecystectomy more urgent. Many of these patients had an abnormal gallbladder; the majority were helped by cholecystectomy; some continued to