Biliary Colic
Upper Abdominal Pain Caused By Gall Bladder Stone Impaction

The stone could also be anywhere along the ducts that connect the gallbladder to the liver and small intestine.

It causes a distinctively severe upper abdominal pain, which often starts in the epigastrium (upper central abdomen just below the breast plate bone).

The pain is often continuous, and could last for 20 minutes to 2 hours. There may be associated restlessness, sweating, nausea and vomiting. There may be jaundice.

Biliary colic, biliary or gallstone sludge, cholecystitis, gallstone pancreatitis and gallstone ileus, are all a continuum in the spectrum of diseases of the gallbladder.

The Gallbladder & Gall Bladder Stones

The gallbladder is a pear shaped sac lying just under the liver.It is where bile is stored. It has a narrow part that joins the liver ducts and those of the pancreas, before they continue as a single drainage duct into the small intestine.

The liver produces about 500 to 1500mLs of bile every day. Some of this amount drains directly into the small intestines where it helps to emulsify fat in our meals for easy digestion.

The remainder amount is stored away in the gallbladder. The gallbladder concentrates the bile about ten times stronger than it was originally. If the bile gets over concentrated, crystals start to form in the solution, leading to stone formation.

There are three types of gallstones. The type of gallstones you form will depend a lot on your diet.The three types of stones are:

• Cholesterol stones

• Pigment stones

• Mixed stones

In the United Kingdom and other affluent industrialized western countries, cholesterol stones are most prevalent. This is mainly because of high fat diet. In poor countries, pigment stones are more common.

Cholesterol stones, as the name suggests, contains cholesterol mainly. Pigment stones contain bilirubin salts (e.g. Calcium bilirubinate).

Up to 15 out of every 100 persons form stones in their gallbladder, and most times, these stones do not cause any problem. In the United States, over 20 million people have gallstones. 80 – 90 % of these are cholesterol stones. This situation is similar in other western countries. One in five women and one in eight men have gallbladder stones.

Risk Factors For Gallstone Formation

• If you are female, fair, fat, fertile of forty or fifty-something years of age of Northern European origin, it is most likely that you will develop gall stones than anyone else. It is also common amongst Pima Indians, North Americans and Chileans.

• Generally Japanese have the lowest incidence of stones.

• Sudden weight loss, prolonged fasting, pregnancy, presence of crohns disease, cystic fibrosis, diabetes, liver cirrhosis, sickle disease, thalassamia, increasing age, extensive bowel resection, use of contraceptives and other medications like largactil, octreotide, and clofibrate will also increase the chances of developing gall stones.

The Gall Bladder Diseases

Most gallstones in the gallbladder do not cause any problem. In fact it is estimated that up to 80% of people who carry stones in their gallbladder do not know, and have no symptoms whatsoever.

Such stones are referred to as silent stones. They may be accidentally picked up by ultrasound scan during investigation of the abdomen for other reasons. Such silent stones that are not causing any problem are better left alone.

Gallstones in the gallbladder can cause a spectrum of problems, referred to as gall bladder diseases.

When stones move to block the collecting systems or ducts of te gallbladder without an associated infection going on in the gallbladder, the affected duct goes into spasm in an attempt to expel the stone. This causes biliary colic.

If stones irritate the wall of the gallbladder, either because of its size, or from prolonged contact and and impaction, for more than 6 hours, plus invasion by bacteria, this could lead to the development of a disease of the gallbladder called Cholecystitis.

The gallstones could also move to block the narrow passage way at the neck of the gallbladder, or smaller stones could migrate out into the collecting system of the liver or into the pancreatic ducts and small intestines. Gallstones in the pancreatic duct will lead to gallstone pancreatitis

When gallstones find their way into the small intestines, they could cause the small bowel from working in what is referred to as gallstone ileus.

Pus collecting in the gallbladder leads to gallbladder empyema. If not relieved, the gallbladder could rupture.

Prolonged irritation of the gallbladder could lead to cancer of the gallbladder.

Symptoms of Biliary Colic

It may spread to the back like cholecystitis, and most people describe the pain as crushing, band-like, and may also spread to the right upper arm. Unlike sudden pain from heart origin, biliary colic pain does not spread to the left arm.

One thing that differentiate biliary colic from cholecystitis, is that the pain usually resolve on time, and there is not an associated fever.

The pain may come back after a while, but patients usually feel well in between (during pain free periods).

There may be vomiting during the height of pain, and patient may try adopting various positions and rolling on the floor in a bid to alleviate the sufferings.

If the stone is successfully expelled from the duct where it is impacted, the pain may resolve and not come back on.

Diagnosis of Biliary Colic

The typical story of biliary colic is one of sudden or insidious onset right upper quadrant abdominal pain "from the blues". It may follow a heavy meal or 1 to 2 hours after a fatty o fried meal.

As stated above under clinical features, there may be sweating, restlessness, vomiting and jaundice. Fever is often absent. Where fever exists, it is most likely that this is cholecystitis.

Where biliary colic is suspected, the best and single investigation is to do an abdominal ultrasound scan.

Other investigations done include plain abdominal radiography (x-ray), ERCP, MRCP, or oral cholecystography.

Treatment of Biliary Colic

The main stay of treatment for biliary pain is the use of strong pain killers like diclofenac taken as 50 mg tablet with food up to three times daily, or ibuprofen also called Medipren or Advil. Though theoretically, administration of opioid pain killers like morphine could make the pain worse by causing the muscles of the sphincter of odi to go into spasm, it is found to be very effective in relieving pain in the acute setting.

In severe causes, patients are admitted into hospital, given intravenous painkillers, and fluids given to replace loss from vomiting.

Definitive treatment of gallstones or gall bladder stones include:

• Open surgical or keyhole (endoscopic) removal of the stone filled gallbladder in an operation known as cholecystectomy
• Use of oral medications referred to as bile salts to dissolve and expel the stones, like Ursodiol or ursodeoxycholic acid also abbreviated UDCA, if surgery is considered unsafe. Some would even try this option first before proceeding to the surgical route. A dose of 300mg daily or twice a day depending on weight, taken for months is often prescribed by gastroenterologists who have made the decision to treat gallstones with tablets.
• Use of a keyhole technique to release the sphincter of the gall bladder duct and pick out the stones, or let the stones "flow out", in a procedure referred to as endoscopic retrograde choliangiopancreatography or ERCP for short. Where there is a stricture or narrowing down the bile passages, the surgeon can widen or dilate such in a procedure we call sphincterotomy.

  ERCP is used for pancreatic problems too.

In a number of individuals, despite suffering with all the features of biliary colic, scans may demonstrate no stone in the gallbladder. If they nevertheless notice that consumption of fatty food triggers pain as described above, going on a low fat gallstone diet for gallstone sufferers may bring them relief.

Have A Concern or Comment About Gall Bladder Stone & Bilairy Colic?

Right upper abdominal pain? Think it might be due to biliary colic? Or do you have you been diagnosed with biliary colic in the past? Any great story or experience on this or related topic? Share it!

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