What is Biliary Colic? Gallstone Pain or Bile Duct Stone Pain

What is biliary colic?

Biliary colic is a sudden attack of severe pain that arises in the upper middle or right upper abdomen near the rib cage, often radiating to the back or shoulder. It is caused most frequently by a gallstone becoming impacted in the cystic duct – the tube that is connected to the gallbladder. Biliary colic may also occur due to an impacted stone in the common bile duct (CBD) – the duct that empties bile into the intestine. The pain of biliary colic is often excruciating and may be accompanied by nausea or vomiting. It may last for a few minutes to several hours and may subside spontaneously or with pain relievers.

The gallbladder is a pear-shaped organ that lies just below the liver on the right side of the abdomen and acts as a reservoir for bile secreted by the liver. The cystic duct drains the gallbladder and the hepatic duct empties the liver. These join to form the common bile duct which ends in the duodenum – the first part of the small intestine. Contraction of the gallbladder discharges bile through the bile duct into the duodenum. Gallstones may form in the gallbladder or CBD and its may be cholesterol stones, black pigment, and brown pigment stones.

What causes biliary colic?

Causes of Biliary Colic

Biliary colic occurs most frequently due to a gallstone becoming lodged in the cystic duct or CBD. Fluid accumulating behind the obstruction distends the ducts and the gallbladder, which is the main cause of biliary colic. Passage of the stone through the cystic duct or CBD where it may also be the cause of pain. Once the stone moves within the duct so that the obstruction is relieved, or if it passes into the duodenum, the pain is likely to subside.

What are the symptoms of biliary colic?

Signs and Symptoms of Biliary Colic

Biliary colic is actually a symptom and not a disease on its own. The most common symptom of gallstones is the pain known as biliary colic. There is usually an attack of sudden, severe pain in the upper abdomen either in the middle or towards the right. This pain occurs frequently at night and may awaken a person from sleep. The pain is steady, may radiate to the back or shoulders, and may be accompanied by nausea or vomiting. It may persist from 15 minutes to several hours. The pain is not made bettwer or worse by movement or a change in position.

Fever and jaundice may occur in case of a stone impacted in the CBD. The pain may subside spontaneously or with analgesics. Biliary colic is likely to recur. Conditions such as gastritis, peptic ulcer, appendicitis, hepatitis, pancreatic disease, angina, and myocardial infarction (heart attack) may be mistaken for biliary colic. Sometimes, one or more of these conditions may occur concurrently, thus making a diagnosis difficult.

What are the tests for biliary colic?

Diagnosis of Biliary Colic

Biliary colic is usually diagnosed from the history and the detection of gallstones. Gallstones are most commonly detected by abdominal ultrasound. Other tests that may also be necessary are :

• Abdominal CT scan.
• Endoscopic retrograde cholangiopancreatography (ERCP) – to locate stones in the CBD.
• Percutaneous transhepatic cholangiogram.
• Endoscopic ultrasound.
• Gallbladder radionuclide scan.
• Magnetic resonance cholangiopancreatography (MRCP).

Blood tests may include bilirubin, liver function tests, and pancreatic enzymes.

How is biliary colic?

Treatment of Biliary Colic

Pain relief may be obtained by nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and ketorolac. Intravenous analgesics like morphine or pethidine is very effective for pain relief but should be reserved for only severe pain.

Biliary colic will resolve by treating the gallstones. The preferred method of treatment for gallstones is by surgically removing the gallbladder, a procedure know as cholecystectomy. Laparoscopic cholecystectomy is the preferred method nowadays. ERCP and sphincterotomy may be done to treat stones in the CBD.

Drugs such as chenodeoxycholic acid (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given orally to dissolve cholesterol gallstones. However, these take a long time to act and gallstones may recur on stopping treatment hence this method of treatment is not so common. Extracorporeal shock-wave lithotripsy (ESWL) is also done less frequently.

How can biliary colic be prevented?

Prevention of Biliary Colic

Ursodeoxycholic acid may be useful in preventing gallstones in high-risk patients. Reducing intake of fatty or spicy food may decrease the occurrence of biliary colic.

Dr. Hannah Cohen

She is a dedicated gastroenterologist, guides individuals to optimal digestive health. Her expertise ensures individuals enjoy a balanced and comfortable digestive system, contributing to overall well-being and vitality.