Biliary Colic

Overview

What is it? The term “biliary colic” is often associated with gallstones. It describes pain in the upper abdomen due to gallstones. This intense, sharp pain may occur in attacks, typically following a heavy meal, and is often accompanied by excessive vomiting and nausea. It is an intense, sharp pain that can come and go in attacks. Typically it follows a heavy meal, and it may be associated with excessive vomiting and nausea.
Why it happens: It happens because a stone hits the wall of the biliary tree (either the gallbladder itself or one of the small tubes connecting the gallbladder with the liver and the bowel).
Frequency: In the Western World, 10-15% of the population has gallstones. Most are asymptomatic and the patients may not even be aware of the presence of gallstones in their gallbladder. Only 1-4% of patients with gallstones will suffer from biliary colic.
gallstones

Symptoms

The main symptom is a sharp pain in the right side of the abdomen just below the ribs. The pain can be so severe that it may affect breathing. Additionally, other symptoms may include fever, nausea, vomiting, sweating, loss of appetite, yellow skin and/or yellowing of the white of the eyes.
Subacute/chronic presentation – Less commonly, a femoral hernia presents as a bulge in the groin area. This bulge may or may not cause pain and may reduce when lying flat. Despite the absence of acute pain, surgical repair is still recommended due to the risk of strangulation.

Diagnosis

Usually, a detailed medical history and a physical examination will suggest the possibility of gallstones. A scan – often an ultrasound, but sometimes a CT or MRI scan – confirms the diagnosis by showing gallstones and gallbladder inflammation. Blood tests can also be informative.

Treatment

Acute cholecystitis treatment typically involves hospital admission. Initially, you will be kept nil by mouth (no eating or drinking), and receive fluids and pain medication. Antibiotics may be necessary if there’s an infection. Antibiotics may also be required if the gallbladder is infected. You will probably require treatment for up to a week – depending on how you respond to treatment you may need to stay in hospital, or you may be able to go home and complete your treatment orally.
The definitive treatment for all patients who are fit to udergo surgery is removal of their gallbladder. The timing for the operation will be decided by your surgeon (see HOT CHOLECYSTECTOMY). The operation prevents acute cholecystitis from coming back and reduces the risk of complications related to gallstones.
For more information on gallstones and biliary colic, visit Mayo Clinic’s page on gallstones
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Follow Up

If you’ve had an episode 
  • It is important to follow all your doctor’s instructions, take any medication prescribed regularly and keep your follow-up appointments.
  • Getting out of bed and walking is an important part of recovery and helps prevent complications.
  • Try to follow a healthy diet and ideally to lose some weight in anticipation of your surgery. If you had your surgery (see HOT CHOLECYSTECTOMY) then follow the postoperative instructions of your surgeon
  • Usually you should be able to go back to a normal diet withing 2-4 weeks from the episode of acute cholecystitis.
  • Take steps to avoid becoming constipated. Eat lots of fiber, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.
Seek immediate medical attention if
  • You are having symptoms of acute cholecystitis
  • If the pain excruciating and is lasting for hours
  • If you are jaundiced (turned yellow), your urine is very dark or your stool is pale