Biliary Colic Flashcards
def
also known as a gallbladder attack
gallstone temporarily blocks the bile duct
pain in the RUQ which can radiate to the shoulder
pain usually lasts a couple of hours
aetiology
obstruction of common bile duct or cystic duct by a gallstone
may be induced by fatty foods
SM of the bile duct contract strongly in an attempt to move the stone, this causes the pain of biliary colic
risk factors
cholesterol gallstone formation risk factors include:
- age
- female
- family history
- obesity
- OCP
- DM
history
pain in RUQ which can radiate to the shoulder
pain can occur after a large fatty meal
sharp pain
pain usually lasts a couple of hours (colicky pain)
nausea & vomiting
indigestion
examination
RUQ pain
collins sign (radiation to the right scapular)
patients often present with normal vital signs whereas patients with cholecystitis are usually febrile and present with malaise
investigations
1 USS of RUQ is gold standard 2 bloods -FBC -LFTs -lipase
RAISED bilirubin & alkphos suggests common bile duct obstruction
3 ERCP
- if lab tests suggest bile duct obstruction
- therefore ERCP is diagnostic & therapeutic
management
medication
-relief of symptoms (antiemetics for nausea, NSAIDs for pain)
-correction of electrolyte & fluid imbalance
surgery
-cholecystectomy
why would antibiotics be given in cholecystitis and not biliary colic
in biliary colic, infection is not a concern therefore antibiotics are not required
complications
obstruction of the bile duct by gallstones can lead to cholecystitis or cholangitis or pancreatitis
biliary pain in the absence of gallstones, known as postcholecystectomy syndrome can severely impact QOL
what is cholangitis
inflammation of the biliary tree
prognosis
if gallstones are not removed from common bile duct or cystic bile duct there is risk of repeated episodes of biliary colic
also a 25% chance of acute cholecystitis in the next 10-20yrs
epi
annual risk is 2-3%