Biliary Colic

Question 1

def

Answer 1

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

Question 2

aetiology

Answer 2

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

Question 3

risk factors

Answer 3

cholesterol gallstone formation risk factors include:

• age
• female
• family history
• obesity
• OCP
• DM

Question 4

history

Answer 4

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

Question 5

examination

Answer 5

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

Question 6

investigations

Answer 6

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

Question 7

management

Answer 7

medication
-relief of symptoms (antiemetics for nausea, NSAIDs for pain)
-correction of electrolyte & fluid imbalance
surgery
-cholecystectomy

Question 8

why would antibiotics be given in cholecystitis and not biliary colic

Answer 8

in biliary colic, infection is not a concern therefore antibiotics are not required

Question 9

complications

Answer 9

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

Question 10

what is cholangitis

Answer 10

inflammation of the biliary tree

Question 11

prognosis

Answer 11

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

Question 12

epi

Answer 12

annual risk is 2-3%