Introduction
Biliary colic is defined as the mild pain present in the middle and upper right abdomen area. When the cystic or common bile duct of the biliary tract becomes blocked by stones, it causes abdominal pain, known as biliary colic. Biliary colic often happens after consuming a heavy, fatty meal that causes the gallbladder to contract. Biliary colic pain is intermittent, and it comes and goes. In general, the term "biliary colic" refers to pain brought on by a brief obstruction of the biliary tract that resolves on its own. However, cholecystitis (gallbladder swelling) or cholangitis (inflammation of the bile duct system) will eventually result from a persistent obstruction of the biliary tract or the total obstruction of a stone inside the biliary tree. At that point, the pain will be constant and intensifying.
What Causes Biliary Colic?
Gallstones are made of either bilirubin or cholesterol and develop inside the gallbladder. These stones may remain in the gallbladder and cause no symptoms, or they may pass through the gallbladder and lodge in the cystic or common bile duct, causing pain when the gallbladder contracts. After heavy meals, the gallbladder usually contracts and releases bile into the duodenum (the first part of the small intestine) to help with digestion, which causes pain.
Is Biliary Colic a Common Condition?
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Gallstones are thought to be present in ten percent to 20 % of individuals. About one percent to three percent of these people are asymptomatic.
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Approximately 500,000 Americans need cholecystectomy surgery due to biliary disease of any kind.
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As estrogen affects gallstones' development, biliary colic is more common in women.
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Since the majority of gallstones in the United States are made of cholesterol, obesity, and high cholesterol are also highly associated with biliary colic and gallbladder disease.
What Are the Symptoms of Biliary Colic?
Common signs and symptoms of biliary colic are the following:
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The patient experiences postprandial pain, which is pain after eating a large meal.
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The pain comes and goes and is not constant.
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The pain is typically present in the right upper quadrant of the abdomen, which may radiate to the back. Sometimes, the pain may even radiate to the shoulders.
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Nausea and vomiting.
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The symptoms worsen after eating a fatty meal.
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Patients with biliary colic do not have a fever (afebrile) and show normal vital signs.
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The discomfort can be sharp, tense, or like a persistent dull ache. Colic frequently happens in the evening, particularly following a large meal. Some individuals experience it at bedtime.
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On physical examination, patients with biliary colic typically only experience right upper quadrant or epigastric tenderness.
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Jaundice (skin and eyes turn yellow) is not prevalent with cystic duct obstruction, but it is prevalent with common bile duct blockage because of an increase in direct bilirubin levels.
What Is the Difference Between Biliary Colic and Cholecystitis?
The gallbladder becomes inflamed when someone has cholecystitis. It necessitates immediate medical care. Gallstones are a prevalent cause of cholecystitis, much like biliary colic. Cholecystitis may be a complication of biliary colic. The symptoms of cholecystitis are more severe and last longer than those of biliary colic. The symptoms of cholecystitis are as follows:
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Chronic abdominal pain that worsens.
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Fever.
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Chills.
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Nausea and vomiting.
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Jaundice (yellowish discoloration of the skin).
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Discolored urine and stool.
Biliary Colic:
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Spasmic central epigastric pain is generally felt in the upper right quadrant of the abdomen.
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No fever.
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Tenderness may be present over the gallbladder if it is distended.
Cholecystitis:
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Fever is present
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Tenderness may be present in the right upper quadrant of the abdomen.
What Is the Differential Diagnosis of Biliary Colic?
The differential diagnosis of biliary colic are as follows:
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Hepatitis (inflammation of the liver).
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Cholangitis (inflammation of the bile duct system).
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Mesenteric ischemia (restricted blood flow to the intestine due to blocked and narrow arteries).
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Renal calculi (kidney stones).
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Gastroenteritis (swelling in the stomach and intestinal lining).
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Biliary dyskinesia (a motility disorder affecting the gallbladder and sphincter of Oddi).
How Is Biliary Colic Diagnosed?
Biliary colic can be diagnosed in the following ways:
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Laboratory Tests: A CBC (complete blood count) and liver function tests are two laboratory tests that should be done. To rule out more severe gallbladder pathology, such as cholecystitis or cholangitis, these tests are crucial. White blood cell (WBC) counts above normal raise the possibility of acute cholecystitis or cholangitis. A stone or obstruction in the common bile duct is suggested by elevated liver enzymes such as direct bilirubin, AST (aspartate transaminase), ALT (alanine transaminase), ALP (alkaline phosphatase), and GGT (gamma-glutamyl transferase). Unless biliary colic has developed into cholecystitis, stones in the gallbladder or cystic duct normally do not cause any test abnormalities. Leukocytosis (elevated levels of white blood cells) may be present in the case of cholecystitis.
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Imaging Tests: Abdominal ultrasonography is the initial radiologic examination that is done if a biliary disease is suspected. Ultrasound is more sensitive than abdominal CT (computer tomography) scans at detecting gallbladder stones. However, emergency room doctors frequently use CT scans to diagnose non-specific severe stomach pain because they generally detect gallstones' presence. If all other imaging is inconclusive, endoscopic retrograde cholangiopancreatography (ERCP) can be done to assess for common bile duct stones.
How Is Biliary Colic Treated?
Biliary colic is managed or treated in the following ways:
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Medical Management: Antiemetics, pain medication, and strict adherence to a low-fat diet are all used to treat biliary colic medically. However, because patients generally have several stones, there is a strong probability that the condition will return. Since biliary colic does not have an infectious cause, like acute cholecystitis or cholangitis, antibiotics are not necessary. Ursodeoxycholic acid taken orally has additionally been used to dissolve gallstones.
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Surgical Treatment: Surgery is the primary form of biliary colic treatment. The gold standard for treatment is laparoscopic cholecystectomy. Extracorporeal shockwave lithotripsy may be considered in patients who are poor surgical candidates, although there is a significant risk of stone recurrence. Common bile duct stones can be diagnosed and treated via endoscopic retrograde cholangiopancreatography (ERCP).
What Are the Complications of Biliary Colic?
Some common complications of biliary colic are the following:
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Pancreatitis (inflammation of the pancreas).
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The gallbladder, bile ducts, and liver may become damaged or infected due to persistent bile duct obstructions. Gallbladder inflammation or swelling is one significant side effect.
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Cholangitis (inflammation of the bile duct system).
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Gallbladder perforation.
Conclusion:
Biliary colic is abdominal pain that aggravates after eating, and it occurs due to gallstones obstructing the cystic or the common bile ducts. One should not overlook stomach pain that is severe and persistent. Biliary colic may repeatedly occur despite a gap of months between consecutive attacks. Gallbladder removal surgery is typically successful, and laparoscopic surgery can ensure that a patient recovers quickly.
