By James Myhre & Dennis Sifris, MD 

 Medically reviewed by Robert Burakoff, MD

Gallbladder pain and liver pain are similar in that the organs are situated next to each other and cause pain in the upper right portion of the abdomen (belly). While it can be difficult to differentiate gallbladder pain from liver pain, the location and characteristics of the pain can sometimes offer clues.

Gallbladder pain is often described as sharp and radiating,1 while liver pain tends to be dull and persistent.2 Gallbladder pain can also be felt deeper,3 whereas liver pain is typically more generalized.4 The differences in symptoms are partly attributed to the presence or absence of pain receptors in these organs.

This article helps you distinguish between pain caused by gallbladder disease and liver disease. It also lists some more common reasons your liver or gallbladder hurts and what can be done to diagnose the cause.

How the Liver and Gallbladder Work

The liver and gallbladder are two organs of the gastrointestinal system that work together to aid in the digestion of foods you eat.

The liver is a large organ situated in the upper right portion of your abdomen, just beneath the diaphragm (the muscle that separates your chest cavity from your abdominal cavity).

Among its many functions, the liver helps remove toxins from the blood, regulates and maintains most chemical levels in the body, and secretes a yellowish-green digestive fluid known as bile.5

The gallbladder is a small, pear-shaped organ also located on the right side of the abdomen, just beneath the liver. The gallbladder receives and stores bile secreted from the liver through a series of small ducts.

Whenever you eat food, the gallbladder releases bile through a larger centralized duct (called the common bile duct) into the first part of the small intestine, called the duodenum.5

Bile works by breaking down fats into fatty acids, which can be absorbed and utilized by the body.5

Gallbladder vs. Liver Pain: Differences and Similarities

The location and functions of the gallbladder and liver account for differences in pain in people with gallbladder disease and liver disease. Even so, there can be overlapping symptoms that make it harder to tell one from the other.

Location

The size of the liver and gallbladder play a role in how pain is experienced.

The liver is a large organ, weighing around 3 pounds in adults and is roughly the size of a football. Because of this, the area where pain is felt will be large. The pain will also be more diffuse (spread out) and generalized than in the gallbladder. The pain will often be accompanied by enlargement of the liver, known as hepatomegaly.2

The gallbladder is a much smaller organ, roughly 2-by-4 inches. Because of its size and location just under the liver, the pain will be in a specific area and more deeply felt.3 People with gallbladder pain commonly describe pain just beneath the rib cage and more toward the center of the abdomen (referred to as epigastric pain}.1

At the same time, gallbladder disease can cause inflammation that irritates the right phrenic nerve, which runs alongside it. This can cause the nerve, which services the diaphragm, to "misfire" and shoot pain signals along the entire nerve route. The radiating nerve pain (called radicular pain) may be felt under the right shoulder blade or right back.3

Hepatomegaly can do the same by compressing the right phrenic nerve as it branches into the right side of the diaphragm. The referred pain caused by hepatomegaly is indistinguishable from that caused by cholecystitis (gallbladder inflammation).

Pain Description

Gallbladder and liver pain are often identical and impossible to tell apart without a medical evaluation. That said, the nerves servicing these organs are distinct and can cause different pain experiences.

Visceral pain is the type of pain experienced by organs. Organs like the liver have no pain receptors (nociceptors). Any pain felt is primarily the result of inflammation of the membrane surrounding the organ, called the visceral membrane.4

Because of this, liver pain is often described as dull, vague, aching, and difficult to locate.4

Somatic pain is the type of pain experienced by muscles that are densely populated with nociceptors. The gallbladder is distinct in that it doesn't have nociceptors, but the muscular valves that regulate the flow of bile (called sphincters) do. So, if there is a blockage of any sort, these muscles can go into sudden, violent spasms.6

Because of this, gallbladder pain is often described as acute (sudden), gripping, gnawing, sharp, cramping, or stabbing.3

This doesn't mean that liver pain is always dull or that gallbladder pain is always severe.

With advanced liver disease, severe abdominal pain can develop along with fatigue, abdominal swelling, jaundice (yellowing of the skin and eyes), and other symptoms of acute hepatitis (liver inflammation).4

Similarly, people with long-standing gallbladder disease often experience chronic cholecystitis, characterized by persistent, mild abdominal discomfort that can get worse after eating or drinking alcohol.7

Causes of Gallbladder and Liver Pain 

Gallbladder or liver pain can be caused by many things, including infection, injury, obstruction, or autoimmune disease. A diagnosis by a healthcare provider is needed to pinpoint the cause.

Gallbladder Pain Causes

When investigating gallbladder pain, your healthcare provider will usually start by investigating conditions that cause biliary colic (dull, intense visceral pain caused by the obstruction of a biliary duct). Other causes would be explored if there is no evidence of a blockage.8

Possible causes include:8

• Gallstones: This is the most common cause of cholecystitis, also known as cholelithiasis or acute calculous cholecystitis (ACC).

• Acute acalculous cholecystitis (AAC): This is cholecystitis not associated with gallstones, most often seen in critically ill people.

• Chronic cholecystitis: This is prolonged cholecystitis, most often seen in people with recurrent gallstones.

• Mirizzi syndrome: This is an uncommon situation where a gallstone in an adjacent duct compresses the common bile duct, causing a blockage.

• Bouveret syndrome: This is a rare condition in which a large gallstone blocks the duodenum or the valve that connects the stomach to the duodenum (called the pyloric sphincter)

• Biliary dyskinesia: This a functional disorder in which the motility (rhythmic contractions) of the gallbladder is disrupted, causing the buildup of pressure as bile accumulates.

• Gallbladder polyps: This is a noncancerous overgrowth of tissues inside the gallbladder or bile ducts that can cause an obstruction.

• Gallbladder hydrops; This is a fluid-filled sac that can sometimes develop after a gallbladder infection, causing a blockage.

• Porcelain gallbladder: This is a rare condition in which the inner wall of the gallbladder becomes hardened and calcified.

• Gallbladder cancer: This is a rare form of cancer affecting 20 of every 1 million people worldwide

Liver Pain Causes

Liver pain is often associated with conditions that cause hepatitis and progressive scarring of the liver, known as fibrosis. These include:9

• Acute viral hepatitis: This is liver inflammation caused by recent infection with the hepatitis A, B, C, D, or E viruses.

• Metabolic dysfunction-associated steatotic liver disease (MASLD): This is a condition formerly known as nonalcoholic fatty liver disease (NAFLD) that causes symptomatic liver inflammation.

• Autoimmune hepatitis: This is a disorder in which the immune system targets and attacks liver cells called hepatocytes.

• Cirrhosis: This is the progressive loss of liver function due to extensive scarring of the liver by heavy alcohol use, chronic viral hepatitis, and other causes.

• Hereditary hemochromatosis: This genetic disorder causes the buildup of iron in the liver and other parts of the body.

• Wilson’s disease: This genetic disorder causes the buildup of copper in the liver and other parts of the body.

• Drug-induced liver disease: This is liver inflammation or damage caused by the prolonged exposure or overuse of drugs that are hepatotoxic (toxic to the liver).

• Primary sclerosing cholangitis: This autoimmune disease causes scarring of medium and large bile ducts inside the liver.

• Primary biliary cirrhosis: This is another autoimmune disease that causes scarring of small bile ducts inside the liver.

• Liver cancer: This is the seventh leading cause of cancer in the United States.

What About Pancreas Pain?

Pancreatitis is the inflammation of the pancreas that typically causes sudden, severe pain in the upper left or middle of your abdomen. It can start with dull, aching pain that steadily gets worse after eating high-fat foods or drinking alcohol.10

Severe pancreatitis can also cause nausea, vomiting, and radiating pain to the left shoulder blade or back.11

Among its functions, the pancreas delivers digestive enzymes to the common bile duct via the pancreatic duct. Infection or injury of the pancreas or pancreatic duct can cause acute or chronic pain.

Common causes of pancreatitis include:10

• Gallstones

• Heavy alcohol use

• Certain viral, bacterial, fungal, or parasitic infections

• Hyperlipidemia (high cholesterol and triglycerides)

• Hereditary pancreatitis (a genetic disorder)

• Abdominal trauma

• Certain medications

• Pancreatic cancer

Some cases of pancreatitis are idiopathic, meaning that the cause is unknown.11

Specialists and Testing for Biliary Organ Pain

Gallbladder and liver pain can be diagnosed by a specialist known as a gastroenterologist. Gastroenterologists who focus exclusively on the liver, gallbladder, and pancreas are known as hepatologists.

To diagnose the cause of biliary organ pain, the specialist may order tests and procedures such as:12

• Liver function tests (LFTs): This is a battery of blood tests that measure enzymes that become elevated when the liver, gallbladder, or pancreas is inflamed.

• Abdominal ultrasound: This is a noninvasive imaging tool that can visualize the liver, pancreas, and gallbladder using high-frequency sound waves.

• Computed tomography (CT): This imaging technology composites multiple X-ray images to create three-dimensional "slices" of the liver, pancreas, or gallbladder

• Endoscopic ultrasound (EUS): For this procedure, a long flexible scope is threaded from your mouth to the small intestine to visualize the gallbladder and pancreas using ultrasound.

• Percutaneous transhepatic cholangiography (PTC): This involves the insertion of a needle through the abdominal wall to inject dye into a bile duct. The dye helps enhance X-ray images.

• Endoscopic retrograde cholangiopancreatography (ERCP): This is a minimally invasive procedure similar to EUS that uses X-rays and fluorescent dyes instead of ultrasound.

• Magnetic resonance cholangiopancreatography (MRCP): This is an imaging technique that uses powerful magnetic and radio waves to visualize the pancreas and gallbladder.

• Percutaneous biopsy: This involves the insertion of a cylindrical needle through the abdominal wall to obtain a tissue sample if cancer is suspected.

Summary

Gallbladder pain can be difficult to distinguish from liver pain as both occur on the upper right side of the belly. Gallbladder pain is often sharp, stabbing, deep, and easy to locate. Liver pain tends to be more diffuse, dull, and difficult to locate. Ultimately, the only way to tell the difference is to seek a diagnosis from a gastroenterologist or a hepatologist.

Sources

Espino EA, Kazaleh M, Zaglul J, Frontela O. Acute cholecystitis presenting with atypical radiologic or laboratory findings: a case report. Cureus. 2023;15(6):e41217. doi:10.7759/cureus.41217

Holman A, Parikh N, Clauw DJ, Williams DA, Tapper EB. Contemporary management of pain in cirrhosis: toward precision therapy for pain. Hepatology. 2023;77(1):290–304. doi:10.1002/hep.32598

Carter CT. Acute thoracolumbar pain due to cholecystitis: a case study. Chiropr Man Therap. 2015;23:34. doi:10.1186/s12998-015-0079-2

Klinge M, Coppler T, Liebshutz JM, et al. The assessment and management of pain in cirrhosis. Curr Hepatol Rep. 2018;17(1):42–51. doi:10.1007/s11901-018-0389-7

Aguiar JA, Riaz A, Thornburg B. Biliary anatomy. Semin Intervent Radiol. 2021;38(3):251–254. doi:10.1055/s-0041-1731085

Tjaden J, Patel K, Aadam A. Gallbladder agenesis with refractory choledocholithiasis. Case Rep Gastrointest Med. 2015;2015:747931. doi:10.1155/2015/747931

Yeo DM, Jung SE. Differentiation of acute cholecystitis from chronic cholecystitis: determination of useful multidetector computed tomography findings. Medicine (Baltimore). 2018;97(33):e11851. doi:10.1097/MD.0000000000011851

Lam R, Zakko A, Petrov JC, Kumar P, Duffy AJ, Muniraj T, Gallbladder disorders: a comprehensive review, Disease a Month. 2021;67(7):101130. doi:10.1016/j.disamonth.2021.101130

Ray G. Management of liver diseases: current perspectives. World J Gastroenterol. 2022;28(40):5818–5826. doi:10.3748/wjg.v28.i40.5818

National Institute of Diabetes and Digestive and Kidney Disease. Symptoms & causes of pancreatitis.

National Health Service (UK). Acute pancreatitis.

Matsubara S. Clinical advances in the diagnosis and treatment of biliary tract diseases. J Clin Med. 2023;12(6):2282. doi:10.3390/jcm12062282

By James Myhre & Dennis Sifris, MD
Dr. Sifris is an HIV specialist and Medical Director of LifeSense Disease Management. Myhre is a journalist and HIV educator.