Biliary colic is a type of abdominal pain caused by a temporary blockage of the duct leading out of the gallbladder. Sometimes, but not always, people with gallstones experience biliary colic. The term “colic” refers to the way the pain sometimes starts and stops suddenly, and “bile” refers to the bile or bile duct. Biliary colic is also known as a “gallstone attack” or a “gallbladder attack.”
Biliary colic is a type of pain that usually occurs in the upper part of the abdomen (abdomen), usually on the right side or a little in the center. In some people, it feels like the pain is radiating into their back or right shoulder.
Pain usually starts suddenly. Once started, it is usually a moderate, steady pain. Most commonly, biliary colic occurs within a few hours after a person has eaten a meal, usually a large meal with a lot of fat. Unlike some other abdominal pains, biliary colic does not improve after a bowel movement.
Usually the worst pain occurs about an hour after it starts. Usually, the pain will gradually disappear within one to five hours (when the gallstone is removed from the duct).
However, symptoms of biliary colic do not always follow this pattern. For example, you may have different patterns in the location and pattern of pain.
Most of the time, people with biliary colic have no other symptoms (although sometimes nausea and vomiting are present). For example, people with a fever are less likely to experience symptoms of biliary colic.
If the pain persists, or you have a fever, you may not have biliary colic but a gallstone complication. For example, some people with gallstones develop cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), or cholangitis (infection of the bile ducts).
When to get prompt medical attention
Seek immediate medical attention if you have:
- severe pain
- pain when vomiting
- fever pain
- pain that lasts for hours
- Jaundice (yellowing of the skin)
- dark urine
Most people go on to have biliary colic episodes unless treated. More than 90 percent of people who experience biliary colic for the first time will have another attack at least within ten years.
Gallbladder, bile and bile duct tree
To understand what causes biliary colic, it can be helpful to know a little about the gallbladder and its ducts (called the “biliary tree”).
The gallbladder is a small sac-like organ located below the liver. The liver produces bile, some of which is stored in the gallbladder. Bile is a thick green liquid that helps your body digest food and certain vitamins. Bile exits the gallbladder through a thin duct (cystic duct) that leads to another duct (the common bile duct). Eventually, this duct empties into a portion of the small intestine where bile can help with digestion and absorption of nutrients.
During meals, various physiological signals cause the gallbladder to be squeezed. This helps get bile into the bile ducts. A larger, fatter meal may cause the gallbladder to squeeze harder.
Usually, this squeezing is not a problem. However, if your gallbladder starts to squeeze and something temporarily blocks the bile duct, problems can occur. If this happens, symptoms of biliary colic may result.
Biliary colic can be caused by anything that temporarily blocks the bile ducts, especially the cystic duct. In most cases, gallstones are the culprit.However, biliary colic can also be caused by a stricture of the bile duct, where part of the bile duct becomes smaller on the inside. For example, this can happen with an injury during surgery, pancreatitis, or some other medical condition.The tumor may also block the duct, causing symptoms of biliary colic. However, gallstones are by far the most common cause of biliary colic caused by blocked bile ducts.
Sometimes bile thickens and hardens and gallstones form (also called “cholelithiasis”). Gallstones sometimes form when bile contains too much cholesterol or bilirubin (the normal breakdown product of hemoglobin). Researchers are still studying what causes gallstones to form in some people but not in others. Different types of gallstones have some different risk factors, depending on the composition of the stone. The most common type is cholesterol stones.
Some risk factors for gallstones include:
- pregnant with multiple children
- 40 years old or above
- lose weight fast
- family history of gallstones
- Certain racial backgrounds (eg, Native American)
- Certain diseases in which red blood cells are broken down too much (such as sickle cell disease)
However, some people develop gallstones even without any of these risk factors.
Although gallstones are the most common cause of biliary colic, it is important to realize that most people with gallstones never experience biliary colic or other complications. Most people with gallstones never experience any symptoms.
Diagnosis begins with a complete medical history and clinical examination. Your clinician will ask about your symptoms and other medical conditions. You will also need a physical examination, including a thorough examination of the abdomen. For biliary colic, an abdominal examination is usually normal, except for some possible epigastric tenderness. It is especially important for your clinician to check you for signs of infection (such as fever) or yellowing of your skin (jaundice). This could signal a more serious problem.
Depending on the situation, a medical history and clinical examination may be sufficient to diagnose biliary colic, especially if you already know you have gallstones, or if you have had biliary colic before. However, your clinician also needs to distinguish biliary colic from other conditions that may have some overlapping symptoms, such as pancreatitis or appendicitis. Some of these conditions require prompt medical intervention, such as surgery.
Other types of gallstone complications may also need to be considered. For example, acute cholecystitis (infection of the gallbladder) is more serious than biliary colic and may require hospitalization. Cholangitis (infection of the cystic duct) is another serious condition that can be caused by gallstones.
If you’ve had a previous episode of biliary colic and it feels similar, you may not need to see your healthcare provider right away. If you don’t have long-term or extreme symptoms, fever, jaundice, or other problems, that’s probably fine. If you’re at all unsure whether you’re having an episode of biliary colic, it’s best to see your healthcare provider right away.
You probably already know that you have gallstones. For example, they may be seen in some kind of imaging test done for other reasons. If so, you probably don’t need additional imaging.
However, if you’re not sure if you have gallstones, or if your doctor is concerned about other causes of your symptoms, you may need some imaging tests. An abdominal ultrasound is usually the first place doctors start because it is an inexpensive and non-invasive test.
In some cases, you may need additional testing. This may include some imaging modalities, as follows:
- Hepatobiliary iminodiacetic acid scan (HIDA scan)
- Magnetic resonance cholangiopancreatography (MRCP)
- Computed Tomography (CT)
- Abdominal X-ray
These may help diagnose biliary colic and eliminate other possibilities.
Laboratory tests are also sometimes helpful in diagnosing biliary colic and ruling out other potential causes. Some common blood tests you may need are:
- Complete blood count (CBC)
- Metabolome, including liver function tests (eg, ALT)
- Pancreatic damage tests (eg, amylase)
These tests are also especially important to make sure another, more serious medical problem isn’t a problem.
Management of biliary colic attacks
During a biliary colic attack, pain control is the cornerstone of treatment. Most commonly, this means some type of non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. Other aspects of treatment may include:
- Antispasmodics (such as scopolamine) that may reduce gallbladder spasms
- Antiemetics (to reduce nausea)
Antibiotics do not help with biliary colic because there is no underlying infection. Depending on the situation, you may or may not need to be hospitalized while your symptoms recover.
If you have had an episode of biliary colic, you are likely to have another in the future. You have two main options for managing your symptoms. You can manage your condition with diet (and possibly medication). Or you can choose to have your gallbladder removed surgically.
Most commonly, clinicians recommend cholecystectomy (cholecystectomy) for people with biliary colic. (but if you have gallstones no For biliary colic, this is not standard advice. ) The good news is that because the gallbladder just stores bile and doesn’t do any other important work, its removal isn’t usually a serious problem. (Your liver will still continue to produce bile that can be used for digestion.)
Surgery is the only sure way to resolve the symptoms of biliary colic. Typically, this procedure is recommended laparoscopically using special tools and cameras. Compared to laparotomy, which is a procedure that uses a smaller incision, older procedures opted to use a larger incision in the abdominal wall. There are other types of surgery that use smaller incisions but do not use laparoscopic tools. These minimally invasive procedures may result in shorter hospital stays and faster recovery than laparotomy, but they may not be an option for everyone.
Laparoscopic cholecystectomy is the most common abdominal surgery in the United States. Most people get good results from it. However, some people do experience serious side effects that may require follow-up treatment, such as bile leakage or bile duct damage. Surgery may be more dangerous if you have certain other medical conditions or are pregnant. Especially in these cases, you may want to consider non-surgical options first.
Do people tend to do better if surgery is done right after the initial biliary colic attack, or if they take a “wait and see” approach? We don’t have a lot of good data on this. There is very limited evidence that continuing surgery may reduce hospital stay and the risk of complications. However, there are many factors involved. You will need to work with your healthcare provider to make the best choice for you.
Biliary colic can be a painful and annoying condition. However, it is not as serious as some other problems caused by gallstones. Fortunately, for many people, surgery to remove the gallbladder will be a good option. You may feel better knowing that your biliary colic will never come back after your gallbladder is removed. Work with your healthcare provider to weigh the benefits and possible risks in your particular situation.
Frequently Asked Questions
What are the symptoms of biliary colic?
Symptoms of biliary colic include sudden, persistent pain in the upper abdomen area. In some cases, this pain can radiate to the back or right shoulder. Nausea and vomiting are also potential symptoms for some people. The pain of biliary colic is sometimes described as colic.
Can I have biliary colic without a gallbladder?
Yes, you can have biliary colic without a gallbladder. This is because the temporary blockage affects the bile ducts outside the gallbladder, not the gallbladder itself.
How is biliary colic treated?
Biliary colic can be managed with changes in diet, medication, and lifestyle, or by surgical removal of the gallbladder. It is possible to live a normal, healthy life without a gallbladder; if further episodes of biliary colic are likely to occur, surgical removal is the definitive solution to symptoms.