Biliary colic, also known as symptomatic cholelithiasis, a gallbladder attack or gallstone attack, is when a colic (sudden pain) occurs due to a gallstone temporarily blocking the cystic duct. Typically, the pain is in the right upper part of the abdomen, and can be severe.
How to relieve biliary colic pain?
To treat episodes of colic at home, a person can try:
- drinking plenty of water to stay hydrated
- taking pain relievers such as paracetamol or ibuprofen
- putting a hot water bottle on the painful area to ease discomfort
- gently rubbing or massaging the affected area
What are risk factors for cholelithiasis?
- fair: more prevalent in the Caucasian population 1
- fat: BMI >30 kg/m 2 and hyperlipidemia 3,4
- female
- fertile: one or more children
- forty: age ≥40 years cholelithiasis can occur in young patients with a positive family history; in such cases, the 'familial' factor can substitute for the 'forty' factor 2
What labs are elevated in acute cholecystitis?
What labs indicate cholecystitis?
- Liver tests, blood tests that can show evidence of gallbladder disease.
- A blood test to check the levels of the enzymes amylase or lipase to look for inflammation of the pancreas.
- A complete blood count (CBC)
- Ultrasound testing.
- Computed tomography (CT), a detailed X-ray images of the organs in your belly.
What are the symptoms of bile duct disease?
Signs and Symptoms of Bile Duct Cancer
- Jaundice. Normally, bile is made by the liver and released into the intestine. ...
- Itching. Excess bilirubin in the skin can also cause itching. ...
- Light-colored/greasy stools. ...
- Dark urine. ...
- Abdominal (belly) pain. ...
- Loss of appetite/weight loss. ...
- Fever. ...
- Nausea and vomiting. ...
How can you tell the difference between biliary colic and cholecystitis?
Differentiating Biliary Colic from Acute Cholecystitis Ultrasonography has high sensitivity and specificity for gallstones but a lower yield for stones in the ductal system. Up to one half of stones in the common bile duct are not detected on ultrasonography.
What is biliary colic in medical terms?
Biliary colic is defined as pain in the abdomen, due to obstruction usually by stones in the cystic duct or common bile duct of the biliary tree. It typically occurs after eating a large, fatty meal that causes contraction of the gallbladder.
What is cholelithiasis commonly known as?
Cholelithiasis is the medical term for gallstone disease. Gallstones are concretions that form in the biliary tract, usually in the gallbladder (see the image below).
What is biliary colic gallstones?
Biliary colic can happen when a gallstone blocks a bile duct, causing intense stomach pain. It is also known as a gallstone attack or gallbladder attack. Many people have gallstones without realizing it, as they rarely cause symptoms. But if people experience biliary colic, they may need surgery to remove the stones.
Can you have biliary colic without gallstones?
Acalculous biliary pain is biliary colic without gallstones, resulting from structural or functional disorders; it is sometimes treated with laparoscopic cholecystectomy or endoscopic sphincterotomy. (See also Overview of Biliary Function.
What triggers biliary colic?
Cause. Biliary colic happens when the gallbladder contracts and causes a gallstone to temporarily block the duct that drains the gallbladder. Gallstones are hard masses made up of cholesterol and bilirubin that form in the gallbladder. They can be small and numerous, or large and few.
What are the two types of cholelithiasis?
Gallstones, or choleliths, are solid masses formed from bile precipitates. These “stones” may occur in the gallbladder or the biliary tract (ducts leading from the liver to the small intestine). There are two types of gallstones: cholesterol and pigment stones.
What are the five F's of cholelithiasis?
Background: The time-honoured mnemonic of '5Fs' is a reminder to students that patients with upper abdominal pain and who conform to a profile of 'fair, fat, female, fertile and forty' are likely to have cholelithiasis.
What are three possible treatments for cholelithiasis?
SurgeryLaparoscopic cholecystectomy. Almost all surgeons perform cholecystectomies with laparoscopy. ... Open cholecystectomy. ... Endoscopic retrograde cholangiopancreatography (ERCP). ... Oral dissolution therapy. ... Shock wave lithotripsy.
How is biliary colic diagnosed?
The symptoms of biliary colic include sudden, steady pain felt in the upper area of the abdomen. In some cases, this pain can radiate to the back or right shoulder. Nausea and vomiting are also potential symptoms in some people. The pain from biliary colic is sometimes described as colicky pain.
What are the symptoms of bile duct problems?
Symptoms may include:Abdominal pain in the upper right side.Dark urine.Fever.Itching.Jaundice (yellow skin color)Nausea and vomiting.Pale-colored stools.
How long does biliary colic last?
Some people feel it after bedtime. The worst pain of biliary colic commonly lasts for 30 minutes to an hour, but may continue at a lower intensity for several more hours. The pain stops when the gallstone breaks free of the bile duct and passes into the intestine.
Where does biliary colic feel?
A person with biliary colic typically feels pain in the middle to right upper abdomen. The pain can feel sharp, crampy, or like a constant dull ache. Colic often occurs in the evening, especially after eating a heavy meal. Some people feel it after bedtime.
What is bile?
Bile and digestive enzymes are carried by the bile ducts from the liver, gallbladder, and pancreas to the small intestine.
Why do gallstones form in the gallbladder?
They can be small and numerous, or large and few. Gallstones form due to chemical imbalances in bile or infrequent or incomplete emptying of the gallbladder.
What is it called when you have a gallstone in your pancreas?
That is called cholecystitis. Also, a gallstone that blocks the duct from the pancreas to the intestine can cause inflammation of the pancreas, called gallstone pancreatitis. Gallstone pancreatitis is potentially life-threatening.
How to treat gallstones with pain?
The usual treatment for chronic gallstones with pain is removal of the gallbladder. This organ is not essential to digestive health.
What are the health risks of a blocked bile duct?
Health risks. Prolonged blockages of the bile ducts can lead to serious complications, such as damage and infection in the gallbladder, bile ducts, or liver. One serious complication is swelling or inflammation in the gallbladder. That is called cholecystitis.
Which system transports bile from the gallbladder to the duodenum?
Figure 1 – The biliary system, which transports bile from the gallbladder to the duodenum
How common is gallstone disease?
Use the information in this article to help you with the answers. Gallstone disease is a common condition, affecting around 10-14% in Western populations. Most individuals with gallstones will remain asymptomatic, however on average 1-4% of individuals will develop symptoms secondary to their gallstones.
What is the gold standard for gallstones?
The gold standard investigation* for gallstones is Magnetic Resonance Cholangiopancreatography (MRCP), largely replacing ERCP for diagnostic purposes (Fig. 3). MRCP can show potential defects in the biliary tree caused by gallstone disease, with a sensitivity approaching 100%.
How to diagnose gallbladder cancer?
It can be diagnosed typically by CT imaging (or often noted on histology post-cholecystectomy). Management in uncomplicated cases is via elective cholecystectomy. Its main complications are gallbladder carcinoma and biliary-enteric fistula.
What is the cause of gallstones?
Gallstones form as a result of supersaturation of the bile. There are three main types of gallstones:
Can you readmit a RUQ after cholecystectomy?
Any patient readmitted with RUQ pain post-cholecystectomy, it is important to exclude a retained CBD stone post-operatively. US abdomen scan may be useful, yet if this is unremarkable, then further investigation via MRCP imaging is warranted.
What are the risk factors for bile duct cancer?
Other recognised risk factors include pregnancy and oral contraceptives *, haemolytic anaemia (specifically for pigment stones), and malabsorption (such as previous ileal resection or Crohn’s disease). *Oestrogen causes more cholesterol to be secreted into bile.
Introduction
Risk Factors
- Classically the common risk factors for gallstone disease are colloquially described as the “5 F’s”: Fat, Female, Fertile, Forty, and Family history. Other recognised risk factors include pregnancy and oral contraceptives*, haemolytic anaemia (specifically for pigment stones), and malabsorption(such as previous ileal resection or Crohn’s disease). *Oestrogen causes more ch…
Clinical Features
- Studies have shown for those who aresymptomatic, over 50% will present as biliary colic and 35% as anacute cholecystitis.
Differential Diagnosis
- There are a wide variety of pathologies that can present with RUQ pain. However, differentials to consider include gastro-oesophageal reflux disease, peptic ulcer disease, acute pancreatitis, or inflammatory bowel disease.
Investigations
- Laboratory Test
Certain blood tests can help in the initial evaluation of suspected cases: 1. FBC and CRP – assess for the presence of any inflammatory response, which will be raised in cholecystitis 2. LFTs – biliary colic and acute cholecystitis are likely to show a raised ALP (indicating ductal occlusion), … - Imaging
A trans-abdominal ultrasound (Fig. 2) is one of the most sensitive modalities for visualising gallstone disease and is typically usedfirst line to investigate suspected gallstone pathology. Three specific areas are often visualised on US: 1. The presence of gallstones or slud…
Management
- Biliary Colic
Patients with biliary colic should be prescribed analgesia (regular paracetamol +/- NSAIDs +/- opiates analgesia). The patient should be advised about lifestyle factors that may help control symptoms (and help with future surgery), such as a low fat diet, weight loss, and increasing exer… - Acute Cholecystitis
Patients with acute cholecystitis should be started on appropriate intravenous antibiotics (such as co-amoxiclav +/- metronidazole). Concurrentanalgesia and antiemeticsshould also be prescribed. A laparoscopic cholecystectomy is indicated within 1 week of presentation, as per NICE guidanc…
Complications
- Mirizzi Syndrome
A stone located in Hartmanns pouch (an out-pouching of the gallbladder wall at the junction with the cystic duct) or in the cystic duct itself can cause compression on the adjacent common hepatic duct. This results in an obstructive jaundice, even without stones being present within th… - Gallbladder Empyema
A gallbladder empyema is when the gallbladder becomes filled with pus (Fig. 6). Patients will become unwell, often septic, presenting with asimilar clinical picture to acute cholecystitis. They are associated with significant morbidity and mortality. The condition is diagnosed by eitherUS s…