BILIARY COLIC

Biliary colic is the medical word used to describe a crampy right upper abdominal pain that comes and go repeatedly, commonly due to gall stone in the gall bladder or anywhere along the pathway of the ducts that connect the gallbladder to the liver and small intestine.

Biliary colic, cholecystitis, gallstone pancreatitis and gallstone ileus, all form a spectrum of disease of the gallbladder.

The gallbladder is a pear shaped sac lying just under the liver.It is where bile is stored.

The gallbladder has a narrow part that joins the liver ducts and then that 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 the type of meal you eat.The three types of stones are:

• Cholesterol stones

• Pigment stones

• Mixed stones

In the United Kingdom and of course other affluent industrialized western countries, cholesterol stones are most prevalent.

This is mainly because of high fat diet. In poor countries, pigment stones are commoner.

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

HOW COMMON ARE GALLSTONES

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 gall stones.

WHAT COULD MAKE ME DEVELOP GALLSTONES

Generally Japanese have the lowest incidence of stones.

Sudden weight loss, fasting, pregnancy, 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 GALLBLADDER DISEASE

Most gallstones in the gallbladder do not cause any problem. 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 not causing any problems are better left alone.

Gallstones in the gallbladder can cause a spectrum of problems. If the stones start irritating the wall of the gallbladder, either because of its size, or from prolonged contact and tear, plus invasion by bacteria, then one comes up with 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.

When stones move to block the collecting systems or ducts without an infection going on, the affected duct goes into spasm in an attempt to expel the stone. This causes the pain of biliary colic.Gallstones in the pancreatic duct will lead to 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.


BILIARY COLIC

As explained above, biliary colic arises when a stone is stuck in the exit duct of the gallbladder, liver, or pancrease, and the body is frantically trying to expel it.

This causes severe pain up in the right part of the abdomen.

WHAT IS THE PAIN OF BILIARY COLIC LIKE

The pain usually starts suddenly and is sustained for about 1 - 5 hours and no more except is it cholecystitis.

Biliary colic pain classically starts in the upper abdomen above the umbilicus called the epigastrium, and or move to the right upper abdomen called the right upper quadrant.

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.

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 passed down a larger exit way, the pain may not come back.

INVESTIGATIONS

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

Other investigations done includes ERCP, MRCP, or oral cholecystography.

TREATMENT

ENDOSCOPIC RETROGRADE CHOLIANGIOPANCREATOGRAPHY ERCP

Simply put, it is the use of a narrow tube with well fitted light source and telescope at the end to look into the bile passage ways. It is introduced to into the patient via the mouth down the gullet.

The patient is usually moderately sedated. It is not a painful procedure. The operating surgeon is then able to visualise any gallstone that may be causing obstruction and physically remove it, or crush it into bits.

Where there is a stricture or narrowing down the bile passages, the surgeon can widen or diliate such in a procedure we call sphinterotomy.

ERCP is used for pancreatic problems too. For more information on, ERCP, please Read on

CHOLECYSTECTOMY

This is a surgical operation involving the removal of the gall bladder it self. Once the gallbladder is removed, stones can no longer form to block the ducts, or cause biliary colic...at least not after a while.

Cholecystectomy used to be done as an open operation, cutting through the whole of the right upper abdomen along the margin of the rib cage.

Now, thanks to key hole surgery. Most cholecystectomy are now done by laparoscopic (Keyhole operation) route. Up to one in five cases started off as laparoscopic surgery may have to be converted to open surgery, if there are severe difficulties during the operation, to save the patient's life.

It is a very safe operation, but some have developed complications from this surgery, like any other surgery.

Some believe that biliary colic surgery is unnecessary. You can view that reason in the link above.

MEDICAL TREATMENT

There are medical treatements available for biliary colic and gall bladder diseases, but they are notorious in not offering a cure in the majority of patients.

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