Biliary colic is a steady or intermittent ache in the upper abdomen, usually under the right side of the rib cage. It happens when something blocks the normal flow of bile from the gallbladder. Bile is a liquid that helps to digest fats. Under normal circumstances, bile is made in the liver and stored in the gallbladder. When you eat a meal, bile passes from the gallbladder through the cystic duct and the common bile duct into the small intestine, where it mixes with partially digested food.
Gallstones are the most common reason for biliary colic. If a gallstone blocks either of these ducts, the normal flow of bile into the intestine is disrupted. The muscle cells in the bile duct contract vigorously to try to move the stone, causing the pain of biliary colic. A stricture of the bile duct or a tumor also can block bile flow and cause biliary colic.
A person with biliary colic usually complains of an ache or a feeling of pressure in the upper abdomen. This pain can be in the center of the upper abdomen just below the breastbone, or in the upper right part of the abdomen near the gallbladder and liver. In some people, the abdominal pain spreads back toward the right shoulder blade. Many people also have nausea and vomiting.
Because symptoms of biliary colic usually are triggered by the digestive system's demand for bile, they are especially common after fatty meals. The symptoms also can occur when a person who has been fasting suddenly breaks the fast and eats a very large meal.
After you describe your symptoms, your doctor will perform a physical examination, paying particular attention to the upper right portion of your abdomen (the area of your liver and gallbladder). Ultrasound, the same painless procedure used to produce pictures of babies in the womb, can be used to produce pictures of your abdomen so your doctor can look for gallstones. Blood tests also may be done, especially if you have any fever or if your pain persists.
Most episodes of biliary colic pass after 1 to 5 hours. After the most intense pain passes, your abdomen may continue to ache mildly for about 24 hours.
Because biliary colic is usually related to gallstones, it can be prevented by controlling the risk factors for gallstones. Some of these risk factors, such as heredity, increasing age and pregnancy, are a normal part of life. Others, such as obesity and a high-fat diet, are risk factors you can modify through a healthy lifestyle. Women going through menopause who take estrogen (hormone replacement therapy) are also more likely to develop gallstones and biliary colic.
At first, your doctor may prescribe pain medication and encourage you to eat a fat-free diet. If the first episode of biliary colic is particularly severe, or episodes of colic keep retuning, surgery to remove the gallbladder (cholecystectomy) usually is recommended. This procedure can be done through small incisions using an instrument called a laparoscope. The procedure usually requires only a brief stay in the hospital, and some people can leave the hospital the same day they have their operation. It is the most widely used treatment in people troubled by painful gallstones, because it is very effective and safe, with no complications in more than 90% of cases.
If surgery cannot be done and symptoms of biliary colic are lasting, medication that dissolves gallstones may be used. However, this medication is expensive and can take months or years to work. Also, only small stones will dissolve. Rarely, medication to dissolve gallstones is combined with a procedure called shock-wave lithotripsy, which uses carefully aimed shock waves to break up gallstones. However, in many people treated with medication or lithotripsy, gallstones tend to form again within a few years.
Call your doctor whenever you have severe abdominal pain, with or without nausea and vomiting. If you have symptoms of biliary colic and you suddenly develop a fever and shaking chills, this may signal a gallbladder infection (cholecystitis), so call your doctor immediately.
As long as you have gallstones that can block your cystic duct or common bile duct, you are at risk for repeated episodes of biliary colic. There is also a 25% chance that you will develop acute cholecystitis, or some other complication of gallstones, within 10 to 20 years.
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