Biliary colic

Epigastric pain related to the most common presentation of symptomatic gallstone disease.

Generally a constant and slowly progressive pain that usually follows a meal.

When a meal is ingested, the gallbladder squeezes the bile into the small intestine to digest fat, and during this process gallstones can get stuck in the cystic duct that connects the gallbladder to the main bile duct, the common bile duct.
The gallbladder contraction pushing across such a blockage causes pain, nausea and vomiting.

May awake a patient several hours after eating.

Pain secondary to impaction of a gallstone in the cystic duct and or in the ampulla of Vater, resulting in distension of the gallbladder and or biliary tract.

Biliary tract or gallbladder distension activates visceral afferent sensory neurons.

Pain generally in the of T8/9 dermatomes with pain in the mid epigastrium and right upper quadrant.

Biliary colic pain is usually continuous, mostly in the upper part of the abdomen, back, or right shoulder.

Presenting symptom in 80% of patients with cholelithiasis seeking medical care.

Only 10-20% of patients with gallstones have significant gallbladder pain.

In asymptomatic patients with cholelithiasis 1-2% per year experience biliary pain or gallstone related complications.

Patients have a 66% chance of having recurrent pain over 2 years.

Fat food intolerance is not related to biliary colic.

Pain related to movement of gallstone back into the gallbladder, passes through the ampulla or enters back into the common bile duct.

May be associated with spasm of the sphincter of Oddi.

Complete delivery obstruction can lead to cholecystitis or gallstone pancreatitis.

Nonpain associated biliary colic symptoms are inconsistently improved with cholecystectomy with approximately 44% benefiting, while such patients are more likely to derive benefit in the presence of gallstones than in those with acalculus disease.

Recurrent pain occurs in 20% of people who undergo cholecystectomy and is most common in patients with atypical symptoms and with those with acalculus disease.

Not related to fatty food intolerance.

Similar incidence in all populations with gallstones worldwide.

Because gallstone disease is more common in women the incidence of biliary colic is more common in females.

A rare process in individuals younger than 20 years of age and increases with age, occurring in approximately 2-4% of men older than 60 years and approximately 3-8% of aged matched women.

Pain that lasts more than 6 hours suggests the presence of acute cholecystitis.

Pain described as vague, aching and in general is not sharp in nature.

Not colicky, but constant in nature, with individual variability.

Intensity variable and can be severe, but if prolonged suggests another process.

Most common location is in the epigastrium or right upper quadrant.

In 7% of cases the pain may be retrosternal.

Progression to acute cholecystitis ranges from 10-30%.

Uncomplicated process leaves no persisting symptoms.

Pain generally lasts 30 minutes to up to 6 hours.

Pain peaks in intensity within 30 minutes to 1 hour.

Gradual onset and prolonged pain suggests an alternative diagnosis.

May be associated with nausea, vomiting diaphoresis and inability to find a comfortable position.

Morphine may increase the pain by causing dysfunction of the sphincter of Oddi.

Often follows meals by a few hours and can awaken patients at night.

Repeat bouts of pain in the same day suggest the presence of complications.

Uncomplicated disease is not associated with fever, chills hypotension or other signs of a systemic process.

The presence of abdominal guarding, rebound, absent bowel sounds or the presence of a palpable mass suggest other processes.

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