Biliary colic
Encyclopedia
Biliary colic is pain
associated with irritation of the viscera secondary to cholecystitis
and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis.
Although it is frequently described as a colic
, the pain is steady, starts rapidly, intense and lasts at least 30 minutes and up to several hours. Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation 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.
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 alkaline phosphatase
).
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 (pain without stones), 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
.
(Toradol) and diclofenac
(Voltaren). Hyoscine butylbromide (Buscopan) is occasionally used but is less effective than analgesics.
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).
that joins the caecum and the ileum
, 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.
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
associated with irritation of the viscera secondary to cholecystitis
Cholecystitis
-Signs and symptoms:Cholecystitis usually presents as a pain in the right upper quadrant. This is known as biliary colic. This is initially intermittent, but later usually presents as a constant, severe pain. During the initial stages, the pain may be felt in an area totally separate from the site...
and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis.
Although it is frequently described as a colic
Colic
Colic is a form of pain which starts and stops abruptly. Types include:*Baby colic, a condition, usually in infants, characterized by incessant crying*Renal colic, a pain in the flank, characteristic of kidney stones...
, the pain is steady, starts rapidly, intense and lasts at least 30 minutes and up to several hours. Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
and diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
. Fatty foods can provoke biliary pain, but this association is relatively non-specific.
Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme
concentration, elevation of bilirubin
Bilirubin
Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases...
, gamma-GT and alkaline phosphatase
Alkaline phosphatase
Alkaline phosphatase is a hydrolase enzyme responsible for removing phosphate groups from many types of molecules, including nucleotides, proteins, and alkaloids. The process of removing the phosphate group is called dephosphorylation...
).
Causes
Biliary pain is most frequently caused by obstruction of the common bile ductCommon bile duct
The common bile duct is a tube-like anatomic structure in the human gastrointestinal tract. It is formed by the union of the common hepatic duct and the cystic duct . It is later joined by the pancreatic duct to form the ampulla of Vater...
or the cystic duct
Cystic duct
The cystic duct is the short duct that joins the gall bladder to the common bile duct. It usually lies next to the cystic artery. It is of variable length...
by a gallstone
Gallstone
A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of...
. 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 (pain without stones), and can even be found in patients post-cholecystectomy (removal of the gallbladder), possibly as a consequence of dysfunction of the biliary tree
Biliary tree
The biliary tract is the common anatomical term for the path by which bile is secreted by the liver then transported to the first part of the small intestine, also known as the duodenum...
and the sphincter of Oddi
Sphincter of Oddi
The sphincter of ampulla or sphincter of Oddi is a muscular valve that controls the flow of digestive juices through the ampulla of Vater into the second part of the duodenum. It is named after Ruggero Oddi...
.
Treatment
Pain management is an important part of treating biliary colic. Treatment is often with NSAIDs such as ketorolacKetorolac
Ketorolac or ketorolac tromethamine is a non-steroidal anti-inflammatory drug in the family of heterocyclic acetic acid derivative, often used as an analgesic...
(Toradol) and diclofenac
Diclofenac
Diclofenac is a non-steroidal anti-inflammatory drug taken to reduce inflammation and as an analgesic reducing pain in certain conditions....
(Voltaren). Hyoscine butylbromide (Buscopan) is occasionally used but is less effective than analgesics.
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).
Complications
The presence of gallstones can lead to inflammation of the gall bladder (cholecystitis) or the biliary tree (cholangitis) or acute inflammation of the pancreas (pancreatitis). Rarely, a gallstone can become impacted in the ileocecal valveIleocecal valve
The ileocecal valve, or ileocaecal valve, is of a bilabial papilla structure with physiological sphincter muscle situated at the junction of the small intestine and the large intestine, with recent evidence indicating an anatomical sphincter may also be present in humans) Its critical function is...
that joins the caecum and the ileum
Ileum
The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
, causing gallstone ileus (mechanical ileus
Ileus
Ileus is a disruption of the normal propulsive ability of the gastrointestinal tract.Ileus is commonly defined simply as bowel obstruction. However, authoritative sources define it as decreased motor activity of the GI tract due to non-mechanical causes...
).
Biliary pain in the absence of gallstones may severely impact the patient's quality of life, even in the absence of disease progression.