Gallstones & biliary colic

Question 1

Define biliary colic

Answer 1

Pain resulting from an obstruction of the gallbladder or common bile duct, usually by a stone

Question 2

Characteristics of biliary colic pain

2

Answer 2

Very severe pain that is usually felt in upper abdomen (midline or to the right)
Can also be poorly localised due to visceral nature

Question 3

Aetiology of biliary colic

Answer 3

Occurs due to contractions of the biliary tree in an attempt to relieve an obstruction (e.g. stone)

Question 4

Risk factors for gallstones

5

Answer 4

Fair (caucasian)
Fat
Fertile
Forty
Female

Question 5

Epidemiology of gallstones & biliary colic

1 + 1

Answer 5

10-15% adults in western world develop gallstones

Biliary colic is most common presentation of gallstone disease

Question 6

Presenting symptoms of biliary colic

5

Answer 6

Crampy RUQ pain
Nausea & vomiting
Pain may radiate to right scapula
Pain does NOT fluctuate & has tendency to persist
May present w/ pain following fatty meal

Question 7

Signs of biliary colic on physical examination

2

Answer 7

RUQ pain & epigastric tenderness

Question 8

Investigations for biliary colic

4 + 3 exclusion

Answer 8

Urinalysis, CXR, ECG - to exclude other causes
Ultrasound
look for dilatation of CBD
gallbladder may be thickened
LFT
ERCP
CT - may be useful if other imaging insufficient

Question 9

Management of biliary colic

5

Answer 9

Analgesia
IV fluids
NBM
Surgical - laprascopic cholecystectomy
ERCP

Question 10

Complications of biliary colic

general + 3

Answer 10

Complications of surgery -

Injury to bile duct
Fat intolerance
Post cholecystectomy syndrome

Question 11

Prognosis of biliary colic

Answer 11

Good w/ appropriate treatment