Biliary colic: Description, Causes and Risk Factors
Intense spasmodic pain felt in the right upper quadrant of the abdomen from impaction of a gallstone in the cystic duct.
Alternative Names: Gallstone colic, hepatic colic.
Biliary colic is the medical word used to describe a crampy right upper abdominal pain that comes and go repeatedly, commonly due to gall stone in the gallbladder or anywhere along the pathway of the ducts that connect the gallbladder to the liver and small intestine. The pain usually starts suddenly and is sustained for about 1 - 5 hours and no more except is it cholecystitis. Biliary colic pain classically starts in the upper abdomen above the umbilicus called the epigastrium, and or move to the right upper abdomen called the right upper quadrant.
The main cause of biliary colic is a gall bladder blockage. This blockage may result from a number of things, but the main cause here has been observed to be gall stones that obstruct free flow of gall bladder fluids.
Problems in your bile duct, such as narrowing of the duct, may also cause biliary colic. There may be a problem with your sphincter of Oddi that enters your small intestine. These problems may happen after surgery to remove your gallbladder. You may get biliary colic after an injury to your gallbladder or bile duct. Other causes include pancreatitis, duodenitis, and esophageal spasm.
It may spread to the back like cholecystitis, and most people describe the pain as crushing, band-like, and may also spread to the right upper arm. Unlike sudden pain from heart origin, biliary colic pain does not spread to the left arm.
One thing that differentiates biliary colic from cholecystitis is that the pain usually resolve on time, and there is not an associated fever
. The pain may come back after a while, but patients usually feel well in between.
There may be vomiting during the height of pain, and patient may try adopting various positions and rolling on the floor in a bid to alleviate the sufferings.
A person with biliary colic usually complains of an ache or a feeling of pressure in the upper abdomen
. This pain can be in the center of the upper abdomen just below the breastbone, or in the upper-right part of the abdomen near the gallbladder and liver. In some people, the abdominal pain spreads back toward the right shoulder blade. Many people also have nausea and vomiting.
Because symptoms of biliary colic usually are triggered by the digestive system's demand for bile, they are especially common after fatty meals. The symptoms also can occur when a person who has been fasting suddenly breaks the fast and eats a very large meal.
Other symptoms include nausea or vomiting, flatulence.
Where biliary colic is suspected, the best and single investigation is to do an abdominal ultrasound scan. Other investigation include ERCP, MRCP, or oral cholecystography.
ERCP: It is the use of a narrow tube with well fitted light source and telescope at the end to look into the bile passage ways. It is introduced to into the patient via the mouth down the gullet. The patient is usually moderately sedated. It is not a painful procedure. The operating surgeon is then able to visualise any gallstone that may be causing obstruction and physically remove it, or crush it into bits.
At first, your doctor may prescribe pain medication and encourage you to eat a fat-free dietitian. Medication that dissolves gallstones may be used. However, this medication is expensive and can take months or years to work. Also, only small stones will dissolve. Rarely, medication to dissolve gallstones is combined with a procedure called shock-wave lithotripsy, which uses carefully aimed shock waves to break up gallstones. However, in many people treated with medication or lithotripsy, gallstones tend to form again within a few years.
If the first episode of biliary colic is particularly severe, or episodes of colic keep retuning, surgery to remove the gallbladder (cholecystectomy) usually is recommended. This procedure can be done through small incisions using an instrument called a laparoscope. The procedure usually requires only a brief stay in the hospital and some people can leave the hospital the same day they had their operation. It is the most widely used treatment in people troubled by painful gallstones, because it is very effective and safe, with no complications in more than 90% of cases.
Because biliary colic is usually related to gallstones, it can be prevented by controlling the risk factors for gallstones. Some of these risk factors, such as heredity, increasing age and pregnancy, are a normal part of life. Others, such as obesity and a high-fat diet, are risk factors you can modify through a healthy lifestyle. Women going through menopause who take estrogen (hormone replacement therapy) are also more likely to develop gallstones and biliary colic.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.