Biliary colic

Biliary colic refers to a sudden, severe abdominal pain due to a gallbladder problem. The location of pain may be at the middle of abdomen under the breastbone or at the upper right of the abdomen often radiating towards the shoulder.  ^[1] Most of the time, biliary colic is due to gallstones. ^[2]

Epidemiology

Most patients with gallstones do not manifest symptoms. However when the stones cause obstruction, symptomatic biliary colic ensue which occurs in 1 to 4% of individuals with gallstones per year. ^[3] 15 out of 100 people form gallstones and usually no problems are noted. It is projected that 1 in 5 females and 1 in 8 males have stones in their gallbladder. ^[4]

Causes

The gallbladder is a pear shaped pouch located just under the liver that serves as storage of bile. Bile, which is produced by the liver, aids in the digestion of fats. The gallbladder aside from storing bile also concentrates it. When there is overconcentration, crystals form resulting in stone formation. ^[4]

Risk Factors

The following factors are associated with increased risk of forming gallstones ^{[4] [5]}:

• race: having Northern European origin with Fs (female, fair, fat, fertile, forty or fifty years old), being Pima Indian, North American or Chilean
• pregnancy
• sudden weight loss
• long-term fasting
• presence of other medical conditions like chrohns disease, liver cirrhosis, diabetes, cystic fibrosis and hemolytic disease
• old age
• extensive bowel resection
• contraceptive use
• use of certain drugs such as largactil, octreotide and clofibrate
  

Signs and Symptoms

Biliary colic typically begins in the upper abdomen just above the umbilicus and then moves to the upper right side. ^[4] The pain may last from few minutes to hours. Other associated symptoms are nausea, vomiting, pain after eating especially fatty foods. ^[4][5] Biliary colic may have the same fashion as cholecystitis as pain can also spread to the back, however biliary colic has pain that disappears in time having pain-free episodes and does not cause fever in contrast to cholecystitis. ^[4]

Diagnosis

The medical history of the patient is obtained. Physical examination is done. The usual laboratory procedure done in biliary colic is an abdominal ultrasound scan. ^[4] Other exams are CT scan, endoscopic ultrasound, gastric manometry, MRI, liver and gallbladder scan and abdominal x-rays. ^[5]

Treatment

Obstructing gallstones are usually surgically removed. ^[2] Some oral medications are given like ursodiol or ursodeoxycholic acid  if surgery is rendered unsafe. Pain is often treated with strong pain killers. When there is severe vomiting, patients are hospitalized for fluid replacement. ^[4]

References:

1 http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/28053.html

2. http://www.freemd.com/biliary-colic/overview.htm

3. http://emedicine.medscape.com/article/1950020-overview

4. http://www.abdopain.com/biliary-colic.html

5. http://www.drugs.com/cg/biliary-colic.html