Biliary colic

Question 1

Define

Answer 1

When pain occurs due to a gallstone temporarily blocking the bile duct
Can last hours, associated with nausea and vomiting

Question 2

Aetiology/risk factors

Answer 2

Previous episode of biliary pain (50% have another episode within a year)

• Older age
• Female sex
• Obesity
• Rapid weight loss
• Drugs
• Symptomatic stones, pregnancy, smoking

Question 3

Symptoms

Answer 3

Sudden onset, severe RUQ pain
- Constant in nature
- Nausea and vomiting
- May last hours
- Radiates to back or right scapula and jaundice
- Jaundice is common but can develop with choledocholelithiasis
- Pain worse after fatty meal
If fever present, suggests complication such as cholecystitis, cholangitis or pancreatitis

Question 4

signs

Answer 4

• Right upper quadrant and epigastric tenderness

Question 5

investigations

Answer 5

• Abdominal ultrasound: For symptomatic patients
• CT follow up if unremarkable
• MRCP

Question 6

management

Answer 6

Analgesia

• Rehydration
• NBM
• Elective laparoscopic cholestystectomy (if leads to cholecystitis)

Question 7

complications

Answer 7

• Cholangitis
• Sepsis
• Pancreatitis
• Hepatitis
• Choledocholithiasis
• Gallbladder perforation

Question 8

prognosis

Answer 8

Uncomplicated biliary colic has low mortality