Biliary colic

Biliary colic
Biliary colic is often related to a stone in the gallbladder
Classification and external resources
Specialty	gastroenterology
ICD-10	K80.5
ICD-9-CM	574.20
DiseasesDB	2533
eMedicine	med/224
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Biliary colic, also known as a gallbladder attack, is when pain occurs due to a gallstone temporarily blocking the bile duct. Typically the pain is in the right upper part of the abdomen and it can radiate to the shoulder. Pain usually lasts from one to a few hours. Often it occurs after eating a heavy meal or during the night. Repeated attacks are common.

Gallstone formation occurs from the precipitation of crystals that aggregate to form stones. The most common form is cholesterol gallstones. Other forms include calcium, bilirubin, pigment and mixed gallstones. Other conditions that produce similar symptoms include appendicitis, stomach ulcers, pancreatitis, and gastroesophageal reflux disease.

Treatment for gallbladder attacks is typically surgery to remove the gallbladder. This can be either done through several small incisions or through a single larger incision. Surgery is typically done under general anesthesia. In those who are unable to have surgery, medication to try to dissolve the stones or shock wave lithotripsy may be tried.

In the developed world 10-15% of adults have gallstones. Of those with gallstones, biliary colic occurs in 1–4% each year. Nearly 30% of people have further problems related to gallstones in the year following an attack. About 15% of people with biliary colic eventually develop inflammation of the gallbladder if not treated. Other complications include inflammation of the pancreas.

Pain is the most common presenting symptom. It is usually described as sharp right upper quadrant pain that radiates to the right shoulder, or less commonly, behind the breastbone. Nausea and vomiting can be associated with biliary colic. Individuals may also present with pain that is induced following a fatty meal and the symptom of indigestion. The pain often lasts longer than 30 minutes, up to a few hours. Patients usually have normal vital signs with biliary colic whereas patients with cholecystitis are usually febrile and more ill appearing. Lab studies that should be ordered include a complete blood count, liver function tests and lipase. In biliary colic lab findings are usually within normal limits. Alanine aminotransferase and aspartate transaminase are usually suggestive of liver disease whereas elevation of bilirubin and alkaline phosphatase suggests common bile duct obstruction.Pancreatitis should be considered if the lipase value is elevated; gallstone disease is the major cause of pancreatitis.

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