Biliary colic

Biliary colic or biliary pain, describes a constant, dull, aching pain that is poorly localized over the epigastrium or the right upper quadrant. Although it is frequently described as a colic, the pain is steady, starts rapidly and naturally lasts at least 30 minutes and up to several hours. There may be irradiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea. Fatty foods can provoke biliary pain, but this association is relatively non-specific.

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Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme concentration, elevation of bilirubin, gamma-GT and alcaline phosphatase).

Causes

Biliary pain is most frequently caused by obstruction of the common bile duct or the cystic duct by a gallstone. However, the presence of gallstones is a frequent incidental finding and does not always necessitate treatment, in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the biliary tract, so called acalculous biliary pain, and can even be found in patients post-cholecystectomy (removal of the gallbladder), possibly as a consequence of dysfunction of the biliary tree and the sphincter of oddi.

Treatment

Treatment is dictated by the underlying cause. The presence of gallstones, usually visualized by ultrasound, generally necessitates a surgical treatment (removal of the gall bladder, typically via laparoscopy) but may also respond in some cases to medications (ursodeoxycholic acid) or lithotripsy.

Complications

The presence of gallstones can lead to infection of the gall bladder (cholecystitis) or the biliary tree (cholangitis) or acute inflammation of the pancreas (pancreatitis). Rarely, an impacted gallstone can obstruct the bowel, causing gallstone ileus (mechanical ileus).

Biliary pain in the absence of gallstones may severely impact the patient's quality of life, even in the absence of disease progression.