Biliary Colic

Biliary Colic is steady rather than intermittent as would be suggested by the word colic, which must be regarded as a misnomer, although in widespread use.

Biliary colic begins quite suddenly and may persist with severe intensity for 30 min to 5 h, subsiding gradually or rapidly. The pain is described as a bandlike tightness of the upper abdomen that may be associated with nausea and vomiting. This is due to a normal gallbladder contracting against a luminal obstruction, such as a gallstone impacted in the neck of the gallbladder, the cystic duct, or the common bile duct. The pain is most commonly triggered by fatty foods, but it can also be initiated by other types of food or even occur spontaneously. An association with meals is present in only 50% of patients, and in these patients, the pain often develops more than 1 hour after eating.

An episode of biliary pain persisting beyond 5 h should raise the suspicion of acute cholecystitis. Nausea and vomiting frequently accompany episodes of biliary pain. An elevated level of serum bilirubin and/or alkaline phosphatase suggests a common duct stone. Fever or chills (rigors) with biliary pain usually imply a complication, i.e., cholecystitis, pancreatitis, or cholangitis. Complaints of vague epigastric fullness, dyspepsia, eructation, or flatulence, especially following a fatty meal, should not be confused with biliary pain. Such symptoms are frequently elicited from patients with or without gallstone disease but are not specific for biliary calculi. Biliary colic may be precipitated by eating a fatty meal, by consumption of a large meal following a period of prolonged fasting, or by eating a normal meal; it is frequently nocturnal, occurring within a few hours of retiring.