Biliary Colic Flashcards
Define Biliary Colic?
Pain resulting from obstruction of the gallbladder or common bile duct, usually by a stone.
The pain, which is very severe, is usually felt in the upper abdomen (in the midline or to the right) but can also be poorly localised due to its visceral nature
What is the aetiology of Biliary Colic?
Occurs due to contractions of the biliary tree in an attempt to relieve an obstruction (e.g. due to a stone)
What are the risk factors of gallstones?
Fair (caucasian) Fat Fertile Forty Female
What is the epidemiology of Biliary Colic?
10-15% of people in the adult western world will develop gallstones
Biliary colic is the most common presentation of gallstone disease
What are the presenting symptoms of Biliary Colic?
Crampy RUQ pain
Nausea and vomiting
Pain may radiate to the right scapula
The pain doesn’t fluctuate and has a tendency to persist
Individuals may present with pain following ingestion of a fatty meal
What are the signs of Biliary Colic on physical examination?
RUQ pain and epigastric tenderness
What investigations would you do for Biliary Colic?
Urinalysis, CXR and ECG to exclude other causes (e.g. basal pneumonia, inferior MI) US LFT ERCP CT
Why do we do an US for Biliary Colic?
Look for dilatation of the CBD
Gallbladder wall may be thickened
Why might we do an ERCP for Biliary Colic?
Useful diagnostically and therapeutically
When would we do a CT for Biliary Colic?
If other forms of imaging have been insufficient
What is the management plan for Biliary Colic?
Analgesia IV Fluids NBM Surgical (laparoscopic cholecystectomy) ERCP can also be used to help remove stones or stent a blocked bile duct
What are the main complications of Biliary Colic a result of?
Complications of surgery
What are the complications of surgery in Biliary Colic?
Injury to the bile duct
Fat intolerance
Post-cholecystecomy Syndrome
What is Fat Intolerance due to?
Inability to secrete a large amount of bile into the intestine because the patient no longer has a gallbladder
What is Post-Cholecystectomy Syndrome?
Presence of abdominal symptoms (e.g. duspepsia, nausea/vomiting, RUQ pain) after the removal of the gallbladder
