Biliary Colic Flashcards
what is biliary colic
refers to the pain due to obstruction of the common bile duct or gall bladder
what can be the reason of obstruction
usually gallstones
where is the site of pain
right upper quadrant and midline of abdomen, can radiate to the right scapula too; shoulder and back
aetiology of biliary colic
the gallstone obstructs the gall bladder or CBD, contractions of the biliary tree to release the obstruction causes pain
risk factors for gallstone formation (cholelithiasis)
5 F’s;
female, forty, fair (caucasian), fat and fertile.
weight loss can increase risk too as it causes supersaturation of cholesterol
epidemiology of biliary colic
10-15% of adults in western world will develop gallstones. biliary colic is the most common presentation of gallstone disease
presenting symptoms
crampy RUQ pain radiating to the right scapula, nausea and vomitting. the pain doesn’t fluctuate, and it may be worse after a fatty meal
what do you expect to see on physical examination
epigastric tenderness and RUQ pain
investigations
urinalysis, CXR, ECG, LFT’s, ultrasound, ERCP and CT
why may ECG and CXR may be performed
to eliminate inferior MI, pneumoperitoneum and pneumonia
Expected results
high ALP, ALT, WCC, CRP and bilirubin
expected results on ultrasound
thickened gall bladder wall and dilated common bile duct
management of biliary colic
analgesia, IV fluids, Nil by mouth.
surgical; removal of gall stones by ERCP, laparoscopic cholecystectomy
complications of biliary colic
surgical complications; injury to bile duct, fat intolerance due to less bile, post-cholecystectomy syndrome
what features are representative of post-cholecystectomy syndrome
RUQ pain, nausea, vomiting and dyspepsia (indigestion)
