Biliary colic is a common symptom of gallstone diseases such cholelithiasis and cholecystitis. It presents as severe right upper abdominal cramping pain and nausea. This happens when gallstones obstruct the cystic duct. Gallstones are formed when bile that contains too much cholesterol hardens and becomes a solid stone-like particle.
The term colic is a misnomer. It implies that the cramping comes and goes, whereas biliary colic pain can last for up to three hours. It is relieved when the stone moves back from the cystic duct into the gallbladder or surrounding structures.
Besides pain in the right abdominal quadrant, other symptoms of biliary colic include indigestion and heartburn. Pain can travel to the shoulder and mid-back. Sources are conflicted as to whether or not fatty food intolerance is a symptom. Loss of appetite occurs during acute attacks.
Doctors usually recommend a diet low in fat for gallstone prevention. Weight loss for obese individuals and maintaining ideal weight also is recommended.
Diagnosis and Considerations
Diagnosis of biliary colic can be difficult as epigastric pain is a symptom of many other diseases. It also does not always present as part of a gallstone problem making diagnosis even more problematic. For this reason, the patient's past history and current symptoms are closely evaluated.
The preferred diagnostic test to confirm the presence of gallstones is an abdominal ultrasound. X-rays may also be taken to rule out other problems such as bowel obstruction.
Bed rest is advised until pain is resolved. For recurrent attacks, pain relievers such as NSAIDs and analgesics are suggested. Prescription medication such as diclofenac or narcotic analgesics is given for more severe pain.
If vomiting occurs, IV fluids may need to be given to prevent dehydration during prolonged attacks as well as antiemitic drugs such as metoclopramide or prochlorperazine. Medication that helps dissolve gallstones may be used alone or in conjunction with lithotripsy described below.
Even with preventive measures and noninvasive treatment, most patients who experience biliary colic and gallstones will have recurrences of both problems. Therefore, surgical removal of the gallstones is strongly recommended to prevent further attacks.
A cholecystectomy, the procedure for removal of the gallblader, is elected by patients who want to avoid future complications from gallstone diseases. A laparoscopic cholecystectomy is preferred in patients with atypical biliary colic symptoms such as no pain or flatulent dyspepsia. This procedure involves the use of a laparoscope that uses smaller incisions than a traditional cholecystectomy. Another options is lithotripsy, which uses shock waves to break down the stones in the gallbladder so they will more easily pass through the urine.
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