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Is It Your Appendix or Your Gallbladder Causing That Pain?

It happens all of a sudden—severe pain strikes in your abdomen. You’re not sure what caused it, but you know something isn’t right. You may wonder if there’s a problem causing your appendix pain or if it's your gallbladder.

“It’s common for people to confuse gallbladder disease and a case of appendicitis,” said Edward Charles, MD, a surgeon with Banner Health in Glendale, AZ. You can suddenly notice symptoms for both, and the pain frequently hits on the right side of your abdomen. They are both common in most age groups and affect people of any gender and from all walks of life.

How can you tell the difference between appendicitis and gallbladder disease?

It can be hard to tell the difference when you first notice symptoms. Here are some details about each condition that can help differentiate these types of abdominal pain. 


Your appendix is a small pouch about the size of a finger. It’s attached to the lower right part of your large intestine. Historically, people have believed that the appendix didn’t serve any function. Today, we know that it produces antibodies that protect against bacteria. But other parts of your digestive system serve the same purpose, so you can live without your appendix.

If you have appendicitis, you may notice symptoms more in the lower abdomen. Since it is an infection, symptoms of appendicitis will likely worsen as it progresses. You may have a fever, chills or body aches. It’s not clear what causes appendicitis, and there’s nothing you can do to prevent it.

Appendicitis doesn’t go away. If your pain is severe or getting worse, particularly if it’s on the right side, and it lasts more than six hours, you should seek medical care.

Gallbladder disease

Your gallbladder is a small organ that sits under the liver in your upper right area of your abdomen. Your liver makes bile, and your gallbladder holds the bile and then releases it into the small intestine. But if your gallbladder is removed, your liver releases the bile directly into the small intestine. So, you don’t need your gallbladder.

You can develop gallstones if some of the components of bile harden inside your gallbladder. You can have gallstones without symptoms—they might show up on an imaging study you have for some other reason. If that happens, you don’t need to treat them. You just need to recognize that if you develop symptoms later, gallstones might be the cause.

But in other cases, gallstones can get lodged in your bile duct and cause a gallbladder attack. 

Symptoms of inflammation of the gallbladder (acute cholecystitis) tend to be in the upper, right abdomen, and you might notice pain in your back or chest on your right side. They often occur after you eat and might last up to a few hours. You should see a doctor if these symptoms recur or interfere with your activities.

Women and people of white or Native American descent have gallstones more often than others. You’re more likely to have gallstone disease if you:

  • Are pregnant
  • Are obese
  • Have lost a lot of weight
  • Have diabetes
  • Have abnormal cholesterol levels 
  • Use hormone replacement therapies

But gallstones also occur in a lot of people who don’t have a condition that’s known to increase risk.

It’s also possible to have gallbladder disease without gallstones. This condition can be caused by some serious medical conditions or chronic diseases. Symptoms are similar to those caused by gallstones, but your imaging studies will look normal, and you’ll need a hepatobiliary iminodiacetic acid (HIDA) scan to confirm the diagnosis.  

You may be less likely to develop gallstones if you drink coffee, exercise for 30 minutes a day five times a week and take vitamin C.

How do you know if you have appendicitis or gallstones?

“Ultimately, an imaging study such as a CT scan or ultrasound is required to confirm one condition vs. the other,” Dr. Charles said.

How are these conditions treated? 

Appendicitis and gallbladder disease are both common reasons people go to the ER (emergency room) and are admitted to the hospital. Since you can live without your appendix or gallbladder, the treatment in both cases is to surgically remove the organ. If you have gallstones and you’re not a candidate for surgery, there are medications that might help.

Untreated, the infection that causes appendicitis can spread inside your abdomen and lead to complications. Gallstones that don’t cause pain may not need to be treated, but those that do need medical attention. Otherwise, the gallbladder could become infected, or it could burst.

The bottom line

Sudden pain in your abdomen, especially on your right side, could be a sign of appendicitis or gallstones. If the pain lasts for more than six hours or goes away and returns, seek medical care. Doctors can treat both of these conditions with surgery.

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