Biliary Colic

by Kevin Pederson


Biliary colic or gallstones or bile duct stones, are hard-pebble like deposits that form within the gallbladder. They develop over long periods of time and may be as small as a grain of sand or grow to the size of a lemon. Most gallstones do not cause any symptoms. The chances of pain or other symptoms developing during the first decade are miniscule (less than 2%) and this declines further after the first decade. The preferred treatment is the 'wait and watch' approach with diet playing an important role, but at times surgery is the only option that will provide relief from the pain.

The most common symptom of biliary colic is a mild pain that occurs in the mid to right part of the upper abdomen. Symptoms include:

  • A steady pain just below the right side of the rib cage. Or behind the breast bone. The pain may radiate to the upper back.
  • Nausea and vomiting.
  • The pain and discomfort are not relieved with the help of painkillers or by having a bowel movement.
  • Symptoms do not persist for periods longer than one hour. Pain that persists for a longer period may be caused by acute cholecystitis or another serious condition.
  • Attacks may recur, often after several months or even years.

A small percentage of people with biliary colic may develop gallbladder inflammation, a condition also known as acute calculous or acalculous cholecystitis. This occurs when the gallstones block the bile duct. The symptoms of an inflamed gallbladder are similar to those of bile stones, just more severe, with attacks often lasting for days. People affected by this condition may also develop a fever and experience chills. People experiencing these symptoms should seek prompt medical attention, especially those suffering from diabetes.

Gallstones may also cause chronic cholecystitis which leads to a scarring of the gallbladder. Symptoms of chronic cholecystitis include digestive problems such as gas, abdominal bloating and feeling full after eating small portions of food.

Treatment is usually only resorted to in case the symptoms develop. The exceptions to this rule are people who have undergone weight loss surgery such as liposuction. Those who experience symptoms usually require immediate treatment. Treatment options include:

  • A surgical procedure known as laparoscopic cholecystectomy. It utilizes smaller cuts than conventional surgical techniques and makes for a shorter convalescing time, with patients never being detained for more than a day after the procedure.
  • Endoscopic retrograde cholangiopancreatography (ERCP) and a sphincterotomy may be carried out to pick out gallstones in the bile duct.
  • Certain medications such as chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be prescribed. These medications help to dissolve gallstones but the process is a slow on often taking years and with no guarantee that the gallstones won't recur.
  • Chemicals that can dissolve gallstones may be passed via a catheter into the gallbladder. However, this method of treatment is rarely used due to the toxicity of the chemicals and the risks of recurrence.
  • Electrohydraulic shock wave lithotripsy (ESWL) may be used in case of patients who cannot undergo surgery, but again this form of treatment is rarely used today.
  • A high fiber diet along with plenty of healthy fats may help in reducing the risk of recurrence. Eating refined foods, foods with high levels of cholesterol and animal proteins should all be avoided to prevent a recurrence of gallstones.
  • While occasional alcohol consumption is said to lower the risk of developing gallstones, it can hardly be considered an appropriate food to prevent their occurrence.

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