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Question : I had severe pain last night and went to the ER. I had an ultrasound test. It showed my gallbladder was slightly distended (no stones) and the common bile duct was enlarged. My white blood cell count was 11,000. But my other blood tests were normal...
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Stephen E. Goldfinger, M.D., is the faculty dean for Continuing Education and a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

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December 23, 2011
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A:

Yes, what showed on the ultrasound exam could explain your pain. I suspect your pain was in the upper abdomen, maybe on the right side. If you had pain somewhere else in the abdomen, then another explanation should be considered.

You said your gallbladder was slightly distended and the common bile duct was dilated. This suggests that a small gallstone passed out of your gallbladder, slipped down the common bile duct, where it lodged at its base (where it empties into the duodenum). If that’s true, it could have temporarily blocked the flow of bile into your intestine. And the backup caused the pain from distention of the gall bladder and bile ducts. I assume that the pain has eased, probably because the stone slipped down into the duodenum and bile flow is back to normal.

When the common bile duct is blocked by a gallstone, it may cause blood levels of liver chemistries to rise. But if the blockage is very temporary this might not be the case.

My suspicion that your pain was related to a gallstone would be even stronger if the ultrasound showed stones in your gallbladder. Even without more supporting evidence, my strong hunch is that a small gallstone was the culprit.

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