Biliary Colic: Definition and Clinical Significance

Biliary colic refers to cholecystolithiasis (option C), which is the presence of gallstones in the gallbladder. 1

Understanding Biliary Colic

Biliary colic is the most common acute presentation of gallstone disease, occurring in 1-4% of patients with gallstones annually 2
It represents the typical pain caused by gallstones in the gallbladder (cholecystolithiasis) without overt infection around the gallbladder 3, 4
Biliary colic is the most common manifestation of cholelithiasis, observed in over one-third of people with gallstones over the course of 10 or more years 3

Despite being called "colic," biliary pain typically starts abruptly, persists without fluctuation, and resolves gradually over two to four hours 5
The pain is most frequently epigastric in location rather than in the right upper quadrant as commonly believed 5
Biliary pain lasting longer than five or six hours suggests progression to acute cholecystitis rather than simple biliary colic 6

Acute cholecystitis (option A) is a complication of gallstone disease characterized by inflammation of the gallbladder, typically due to obstruction of the cystic duct by gallstones 1
Cholangitis (option B) refers to inflammation of the bile ducts, often due to infection, which presents with Charcot's triad (pain, jaundice, and fever) 4
Chronic cholecystitis (option D) results from single or multiple recurrent episodes of acute cholecystitis and is associated with gallstones in 95% of cases 1
Biliary pancreatitis (option E) is an acute inflammatory condition of the pancreas caused by gallstones obstructing the common channel between the pancreatic and bile ducts 4

Approximately 80% of patients with gallstones remain asymptomatic throughout their lives 1, 4
By age 75, approximately 35% of women and 20% of men have developed gallstones 2
Untreated gallstones may lead to acute calculus cholecystitis in 10-20% of people with gallstones 2
In patients who do not undergo cholecystectomy after an initial episode of acute cholecystitis, the probability of gallstone-related complications is 14%, 19%, and 29% at 6 weeks, 12 weeks, and 1 year, respectively 2

Ultrasound is the first-line imaging modality for suspected gallstone disease, with 96% accuracy for detection of gallstones 1
Asymptomatic gallstones are typically discovered incidentally during imaging studies performed for other reasons 2, 1
Precise description of the abdominal pain (nature, intensity, location, duration, irradiation) is needed to prevent misdiagnosis 5

NSAIDs are commonly used for pain relief in biliary colic and may decrease the frequency of short-term complications 3
The recommended management for asymptomatic cholelithiasis is expectant, with surgery reserved only for those who become symptomatic 1
Cholecystectomy is generally indicated for symptomatic gallstone disease to prevent recurrent biliary colic and complications 2