Biliary colic is a pain in the upper abdomen and a symptom of gallstones, which affect 10 to 20 percent of adults in the United States. Only about 1 to 3 percent of people are symptomatic, however. Biliary colic can be mild or severe and is the most common symptom of gallbladder disease.
Acute Cholecystitis and Biliary Colic
Biliary colic is an intermittent pain in the right upper part of the abdomen, near the rib cage. It occurs when a gallstone temporarily blocks the bile duct in the gallbladder. The symptom is different from acute cholecystitis, which is a total blockage causing more persistent and intense pain.
Biliary colic typically occurs at night because it is easier for stones to enter the duct when someone is laying down than when they are sitting or standing. The pain lasts for about three hours, and there may be some tenderness when it passes. If the pain lasts longer, the person is likely experiencing acute cholecystitis, not biliary colic.
Gallstones are composed of bilirubin or cholesterol. After fatty meals, chemicals are released in the first section of the small intestine to help break down fats; this also causes the gallbladder to contract. This contraction is what moves stones into the duct, causing the blockage. The gallstones irritate the lining of the ducts, and pain increases as the gallbladder continues to contract.
People with biliary colic most often present with pain after a heavy or fatty meal. Vital signs are typically normal, and they do not develop a fever. In contrast, people with acute cholecystitis or inflammation of the ducts present with tachycardia or increased heart rate and fever. They may have a palpable mass in the right upper abdominal quadrant. If the common bile duct is obstructed, they may present with jaundice. These symptoms indicate that the problem is more serious than biliary colic.
Risk factors for biliary colic are similar to the risk factors for gallstones. They include obesity, recent rapid weight loss, pregnancy, advanced age, and Northern European ancestry. Women are more likely to develop gallstones than men. Liver transplant recipients are at increased risk for gallstones and biliary colic, as well. Smoking and alcohol also increase the risk.
Diagnosis and Reoccurrence
About 70 percent of patients who have an episode of biliary colic will have a second episode. Some physicians may recommend surgery to prevent more in the future. Additionally, most people with acute cholecystitis have had prior episodes of biliary colic. Gallstones are commonly diagnosed with ultrasound, though they do not always detect stones in the ducts.
Treatment and Surgery
Laparoscopic cholecystectomy is the most common surgical treatment for gallstones, and doctors commonly recommend it for those who experience episodes of biliary colic. Patients can control the symptoms with pain meds and a healthy diet while waiting for surgery. They do not need to be hospitalized in the interim unless they have severe pain or cannot eat or drink.
For those who are unable or unwilling to have surgery, nonoperaive management is possible. Education is paramount in these cases as patients need to know the warning signs of acute cholecystitis and when to seek emergency care. These patients are at high risk for repeat attacks and infectious processes, like cholangitis and cholecystitis. Nonoperative management is not recommended by most physicians.
The best way to prevent biliary colic is to prevent gallstones. Maintaining a healthy weight is key, as obesity is a big risk factor, but weight loss should be pursued in a healthy way, as fasting or skipping meals also increases the risk of gallstones. Those trying to lose weight should aim to lose about one or two pounds a week, as rapid weight loss is yet another risk factor. Doctors also recommend high-fiber diets.
Asymptomatic to Symptomatic
Many people with gallstones do not even know they have them. Most are asymptomatic, but they become symptomatic at a rate of 2 percent a year. The most common symptom of gallstones is biliary colic. Once this occurs, it reoccurs for between 20 to 40 percent of patients every year.