What is Biliary Colic: Causes, Symptoms, Treatment, Complications

Biliary colic is the pain in the gallbladder which occurs due to the obstruction of the cystic duct or the common bile duct by the gallstone. The pain is a steady type or intermittent and is accompanied by nausea and vomiting. It starts in the upper abdomen and radiates to the shoulder and sometimes to the right shoulder blade.

Pain in the gallbladder or the biliary colic occurs because of the obstruction of the normal flow of bile.

Bile is a liquid formed in the liver and stored in the gallbladder. It helps in digestion of fats. It passes from the cystic duct to the common bile duct to the intestine, where it mixes with the partially digested food. A stone in the cystic duct or the common bile duct obstructs the flow of bile. Therefore, as the gallbladder contracts, the pain occurs.

Sometimes the biliary colic is because of functional disorder of the biliary tract and occurs even after removal of the gallbladder.

As biliary colic is associated with gallstones obstructing the ducts, following are the risk factors of gallstones.

• Age: As the age advances the risk of gallstones increase.
• Females: Gallstones risk is found more in females than males.
• Pregnancy: Pregnant and post-pregnant females stand more chances of gallstone formation. Progesterone relaxes the muscular tissue of the body. This slows down the contraction of the gallbladder. Due to slow contractions bile doesn’t get released and this leads to the formation of gallstones. It is more common in the third trimester or after pregnancy.
• Obesity: High BMI (body mass index) increases the risk of gallstones especially in females.
• Prolonged Fasting: Bile is formed in the liver and stored in the gallbladder and is released into the small intestine to digest fatty food. Prolonged fasting leads to conversion of stored fat into energy and thus bile may stay in the gallbladder for a longer period of time.
• Diabetes: Having high levels of triglycerides and fatty acids, diabetics are at a greater risk of gallstone formation.
• Family History: Risk of gallbladder disease increase if there is a family history of obesity, high cholesterol levels, diabetes.
• Diet: Dietary factory can make gallstone formation more likely. Research suggests that a high-calorie diet, processed carbohydrates, and sweets increase the risk of gallstone formation⁽¹⁾.

The patient experiences a sharp pain postprandial pain in the upper abdomen. The pain is either continuous or occurs at a period of small intervals. It is sharp, crampy, or a constant dull ache and radiates to the right shoulder and at times to the right shoulder blade. It generally occurs after eating, especially fatty food.

Some patients also report nausea and vomiting along with the pain all of which accentuates after meals.

The pain mostly resolves in 30 to 90 minutes as the gallbladder relaxes.

As the patient visits the doctor with a biliary colic a complete medical history, laboratory tests and the ultrasound of the abdomen, are conducted to find out the cause of the obstruction and pain.

Biliary colic requires treatment as the attack can recur anytime with unknown intensity.

Immediate treatment of biliary colic lies with the relief of symptoms. Pain killers and anti-emetic are given to the patient. Electrolyte and fluid imbalance caused by vomiting is corrected.

Surgical removal of the gallbladder or cholecystectomy is the most common treatment for biliary colic. The gallbladder is not considered an essential organ and the body can very well function without it.

The surgery is performed in two ways:

1. Laparoscopic Cholecystectomy: In this option, small incisions are made in the abdomen through which a thin tube with a video camera is inserted. The camera guides the surgeon where to operate to remove the gallbladder.
2. Open Cholecystectomy: When the gallbladder is scarred or inflamed, open surgical procedure is done. A large cut of 4-6 inches is made in the abdomen for the gallbladder removal.

Both the procedures are done under anesthesia. The most preferred option is laparoscopic cholecystectomy because it has a quicker recovery.

The cases in which surgery is not possible, then medication and therapy are used. Small gallstones can be dissolved with medications.

Shock wave lithotripsy is another treatment option in which an ultrasound is used to find the gallstone, after which a machine sends a shock to break the gallstone. This doesn’t require any cut or incision on the skin.

Blockage of the bile duct for long can lead to serious complications such as infection or damage to the gallbladder, bile ducts, and liver.

Cholecystitis, which is the swelling and inflammation of the gallbladder, is one serious complication which can occur as a result of neglecting the biliary colic.

If the gallstone blocks the duct from the pancreas to the intestine, it can inflame the pancreas. This is known as gallstone pancreatitis which can prove to be life-threatening.

It is therefore important not to neglect any kind of abdominal pain even if it occurs at long period intervals. Get consulted and treated to avoid the unwanted complications.

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