From the Guidelines
Biliary colic is a type of abdominal pain caused by temporary blockage of the bile ducts, typically by gallstones, characterized by sudden, severe, and steady pain that is unaffected by household remedies, position change, or gas passage. This condition is often mistaken for a heart attack or abdominal catastrophe, and its symptoms can be upsetting for patients 1. The pain usually occurs in the right upper quadrant or middle of the abdomen and may radiate to the right shoulder or back. It generally comes on suddenly, builds to a steady intensity, and can last from 30 minutes to several hours before gradually subsiding.
Key Characteristics of Biliary Colic
- Sudden onset of severe and steady pain
- Pain is typically felt in the right upper quadrant or middle of the abdomen
- Pain may radiate to the right shoulder or back
- Pain is constant and steady, not colicky (coming and going)
- Pain is unaffected by household remedies, position change, or gas passage
Diagnosis and Treatment
Diagnosis of biliary colic is based on clinical history and can be confirmed by ultrasonography, oral cholecystography, or plain roentgenography 1. Treatment for acute episodes includes pain management with NSAIDs or opioids, and patients should avoid fatty foods that can trigger attacks. The definitive treatment for recurrent biliary colic is usually surgical removal of the gallbladder (cholecystectomy). If left untreated, complications can develop, including cholecystitis, pancreatitis, or cholangitis.
Importance of Early Intervention
Early intervention is crucial to prevent future biliary pain, biliary complications, gallbladder cancer, or death 1. The decision to prevent these outcomes should be made by the clinician and patient, taking into account the patient's individual circumstances and the potential risks and benefits of treatment.
From the Research
Definition of Biliary Colic
- Biliary colic is the most common clinical presentation of symptomatic gallstone disease, which can occur in the gallbladder (cholelithiasis) or common bile duct (choledocolithiasis) 2.
- It is characterized by abdominal pain, typically located in the epigastric region or right upper quadrant, which can be severe and may radiate to other areas 2, 3.
Symptoms and Diagnosis
- The pain of biliary colic usually starts abruptly, persists without fluctuation, and resolves gradually over 2-4 hours 2.
- Biliary colic is often preceded by "warning" episodes of colic, which can be a sign of underlying gallstone disease 4.
- Diagnosis of biliary colic can be made using non-invasive imaging techniques such as abdominal ultrasound and magnetic resonance cholangiography 2.
- A precise description of the abdominal pain, including its nature, intensity, location, duration, and radiation, is essential for accurate diagnosis and prevention of misdiagnosis 2.
Relationship with Gallstones
- Biliary colic is a specific symptom of gallstones, and its presence can increase the diagnostic odds ratio for gallstone disease 5.
- However, not all patients with gallstones experience biliary colic, and other abdominal symptoms can also be present 5, 6.
- Biliary dyskinesia, a motility disorder of the gallbladder, can also cause biliary colic in the absence of gallstones 6.
Complications and Management
- Biliary colic can be a sign of underlying complications such as cholecystitis, choledocholithiasis, and cholangitis, which require prompt medical attention 4, 6, 3.
- Management of biliary colic and its complications may involve supportive care, antibiotics, and surgical intervention such as cholecystectomy 4, 6, 3.