Biliary colic

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Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis.

Although it is frequently described as a colic, the pain is steady, starts rapidly and lasts at least 30 minutes and up to several hours. Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea. Fatty foods can provoke biliary pain, but this association is relatively non-specific.

Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme concentration, elevation of bilirubin, gamma-GT and alkaline phosphatase).

Causes

Biliary pain is most frequently caused by obstruction of the common bile duct or the cystic duct by a gallstone. However, the presence of gallstones is a frequent incidental finding and does not always necessitate treatment, in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the biliary tract, so called acalculous biliary pain, and can even be found in patients post-cholecystectomy (removal of the gallbladder), possibly as a consequence of dysfunction of the biliary tree and the Sphincter of Oddi.

Treatment

Pain management is an important part of treating biliary colic. Treatment is often with intra venous analgesics such as narcotics or ketorolac (Toradol). Hyoscine butylbromide (Buscopan) is occasionally used but is less effective than analgesics.^[1]

Treatment is dictated by the underlying cause. The presence of gallstones, usually visualized by ultrasound, generally necessitates a surgical treatment (removal of the gall bladder, typically via laparoscopy) but may also respond in some cases to medications (ursodeoxycholic acid) or lithotripsy.

Complications

The presence of gallstones can lead to infection of the gall bladder (cholecystitis) or the biliary tree (cholangitis) or acute inflammation of the pancreas (pancreatitis). Rarely, a gallstone can become impacted in the ileocecal valve that joins the caecum and the ileum, causing gallstone ileus (mechanical ileus).

Biliary pain in the absence of gallstones may severely impact the patient's quality of life, even in the absence of disease progression.

References

External links

• Diagram of pain radiation
• Overview at psu.edu

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