Biliary Colic Flashcards
What is biliary colic?
Biliary colic is a sudden painful spasm of the gallbladder wall triggered by a gallstone. This term can also describe gallstone-related spasms of the cystic duct or common bile duct.
What is biliary colic the most common complication of?
Gallstones
What is the aetiology of biliary colic?
Biliary colic usually occurs when a stone gets stuck in the gallbladder neck or the cystic duct, obstructing bile flow.
The gallbladder contracts to dislodge the stone, and its wall stretches and distends, causing visceral pain. Depending on its size, the stone will either pass into the common bile duct, drop back into the gallbladder, or become completely impacted and remain stuck.
Where does the gallbladder receive its arterial blood supply from?
cystic artery (a branch of the right hepatic artery)
Which veins does the gallbladder drain into?
multiple small cystic veins into the right portal vein
What is the role of the gallbladder?
to concentrate and store bile, releasing it when required
What is the function of bile? (2)
1) neutralising gastric acid
2) emulsify fat
What cells synthesise bile?
hepatocytes
What hormone stimulates the release of bile form the gallbladder into the duodenum?
cholecystokinin
What cells release cholecystokinin?
I cells
What is the clinical presentation of biliary colic?
pain in the epigastric region or RUQ that radiates to the right scapula or shoulder - indicative of cholecystitis
Eating what 2 types of food can often precede an episode of biliary colic?
- fatty foods
- Spicy foods
What autonomic symptoms are experienced with biliary colic?
- Nausea
- Vomiting
- Sweating
- Palpitations
How long does an isolated episode of biliary colic last?
about 6 hours and subsided once the stone is dislodged
What type of pain is experienced in biliary colic?
Dull and constant with waves of more intense pain
in biliary colic what is the expected results of inflammatory markers and LFTs?
Most cases they are normal
How does biliary colic differ from acute cholecystitis?
Unlike biliary colic which typically manifests as episodic pain following meals, acute cholecystitis often presents with persistent right upper quadrant (RUQ) pain lasting more than 6 hours.
Fever and systemic signs of inflammation such as leukocytosis are common in acute cholecystitis but uncommon in biliary colic.
Murphy’s sign - an inspiratory arrest during deep palpation of the RUQ - is positive in acute cholecystitis but not in biliary colic.
How does biliary colic differ from peptic ulcer disease?
Pain due to PUD is usually located in the epigastric region and may radiate to the back, whereas biliary colic pain is typically felt in the RUQ or epigastrium and may radially refer to the right scapula.
PUD pain tends to be chronic, gnawing or burning and often relieved by food or antacids; conversely, biliary colic pain is severe, crampy and typically triggered by fatty meals.
Additional symptoms such as heartburn, regurgitation or dyspepsia might suggest PUD over biliary colic.
How does biliary colic differ from gastroesophageal reflux disease?
While both GORD and biliary colic can present with epigastric pain, GERD is more likely to be associated with heartburn, regurgitation, and dysphagia.
Pain from GORD often occurs after meals and may worsen when lying down or at night; this contrasts with biliary colic where pain usually occurs 1-2 hours post-prandially and lasts for 1-5 hours.
Unlike biliary colic, GERD symptoms may improve with antacid use.
What is Mirizzi syndrome?
Mirizzi syndrome is a rare but serious condition involving the gallbladder and bile ducts. It occurs when a gallstone (or gallstones) in the gallbladder or cystic duct causes obstruction and compression of the common hepatic duct or common bile duct, leading to jaundice and other symptoms related to bile duct blockage.
How many types of mirizzi syndrome are there?
4
What is type 1 mirizzi syndrome?
Simple external compression of the common bile duct by the stone in the cystic duct or gallbladder neck.
What is type 2 mirizzi syndrome?
A fistula (abnormal connection) forms between the gallbladder and the common bile duct due to the pressure from the stone. This leads to a communication between the two structures.
What is type 3 mirizzi syndrome?
Involves more complex fistulas, and the stones may erode further into the bile duct causing more extensive damage.
What is type 4 mirizzi syndrome?
Multiple fistulas develop, and the stone or stones erode into both the gallbladder and bile duct.
What are the symptoms of mirizzi syndrome?
Jaundice (yellowing of the skin and eyes)
Pain in the upper right abdomen (similar to biliary colic or gallbladder pain)
Nausea and vomiting
Fever and chills (if an infection like cholangitis occurs)
Clay-colored stools (due to lack of bile)
Dark urine (due to increased bilirubin)
