Question

One day 23 years ago, at age 42, Hakim ate a lunch of extra greasy fried fish and chips. Two hours later, he was doubled over with the worst pain he had ever felt in the pit of his stomach. At first, he thought he was having a heart attack, but the pain came and went in several waves every few minutes, and radiated toward his right side. So then he thought maybe it was an ulcer. Amid the third wave of pain, Hakim vomited copiously, and the pain immediately subsided. He decided it must have been food poisoning, and vowed never to eat at that place again.

Four days later, following a breakfast of profoundly greasy sausage and hash browns, Hakim again suffered the same symptoms, which again subsided after vomiting. This time, he went to the doctor, and was diagnosed with gallstones. He had surgery to remove his gallbladder, and gladly said goodbye to that troublesome bag of bile.

So imagine his surprise when one night, 23 years later, he’s jolted awake at 4am with the same symptoms. Well… almost the same, he observes after again vomiting. This time, his last meal was 10 hours prior, and was rice and vegetables with only a dash of peanut oil. (Hakim has cleaned up his diet considerably in the last few years.) The pain again comes and goes every few minutes, but vomiting does not relieve it, and it’s in the left side of his abdomen, radiating down to his groin. Also, whereas previously the pain had made him want to curl into a fetal position, this time, between the overwhelming pain and the overwhelming urge to urinate, he is continually squirming and can’t stay still. Hakim doesn’t know much about anatomy or medical issues, so he wonders if maybe his gallbladder has grown back. He goes to the emergency room, and is at least relieved to hear that his gallbladder is still indeed permanently gone. This is small comfort, however, given the intensity of the pain and the diagnosis that he now has a similar condition in another organ system.

What is the most likely cause of Hakim’s problem this time? Why are both conditions characterized by pain that comes in waves every few minutes? And why was the pain 23 years ago brought on by eating greasy food?

Answer 1

The most likely cause of Hakim's problem this time is Kidney Stones. Pain due to kidney stone is characterised by abdominal pain that radiates to the groin with the overwhelming urge to urinate.

Stones in gall bladder and kidneys causes pain that comes in waves every few minutes. This is because of the obstruction caused by the stones blocking the transport of bile in the case of gall bladder and the blockage of urine drainage through the ureter in the case of kidneys. The periodical blockage of the transport by the stone, which is trying to move out of the kidney/gall bladder is the reason for the wave pattern of pain.

Greasy food contains lots of fat which needs to be emulsified before it is broken down by the action of lipases. Emulsification of fats is done by bile which is produced in the gall bladder. When the greasy food reaches the stomach, it signals the gall bladder to produce bile for initiating the digestion process i.e., emulsification of fats. Since the stone in the gall bladder obstructs the flow of bile, the gall bladder repeatedly contracts to relieve the blockage which causes the severe pain.