Gallstones & Biliary Colic Flashcards
Definition (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.
Aetiology
Occurs due to contractions of the biliary tree in an attempt to relieve an obstruction
(e.g. due to a stone)
Risk factors (gallstones)
5 F’s
o Fair (Caucasian) o Fat o Fertile o Forty o Female
Epidemiology
- 10-15% of people in the adult Western world will develop gallstones
- Biliary colic is the most common presentation of gallstone disease
Presenting symptoms
- Crampy RUQ pain
- Nausea and vomiting
- Pain may radiate to the right scapula
- The pain does NOT fluctuate and has a tendency to persist
- Individuals may present with pain following ingestion of a fatty meal
Sings on physical examination
RUQ pain and epigastric tenderness
Investigations
• Urinalysis, CXR and ECG to exclude other causes (e.g. basal pneumonia, inferior MI)
• Ultrasound
o Look for dilatation of the CBD
o Gallbladder wall may be thickened
- LFT
- ERCP - useful diagnostically and therapeutically
- CT - may be useful if other forms of imaging have been insufficient
Management plan
- Analgesia
- IV fluids
- NBM
• Surgical
o Laparoscopic cholecystectomy
• ERCP can also be used to help remove stones or stent a blocked bile duct
Possible complications
• Complications of surgery
o Injury to the bile duct
o Fat intolerance - due to inability to secrete a large amount of bile into the
intestine because the patient no longer has a gallbladder
o Post-cholecystectomy syndrome - presence of abdominal symptoms (e.g.
dyspepsia, nausea/vomiting, RUQ pain) after the removal of the gallbladder
Prognosis
GOOD prognosis with appropriate treatment
