Biliary colic

Caused by a stone impacted within the gallbladder – usually within Hartmann’s pouch or the cystic duct.

Clinical features:

• Waves of pain in the epigastrium and right upper quadrant
• Pain radiates through to the back, in the region of the inferior angle of the scapula
• Attacks of pain last for between 15mins to 7hrs
• Pain is often exacerbated by ingestion of fatty foods (as these stimulate the release of CCK, which causes gallbladder contraction)
• Vomiting is common

Investigations:

Plain X-Ray:

Reveals only 10% of gallstones (the remainder have insufficient radio-density)

Ultrasound:

Detects 98% of gallbladder stones

Less reliable at detecting stones within the bile ducts

Provides additional information on:

Thickness of the gallbladder wall

Diameter of the common bile duct

Architecture of the liver and pancreas

Mx:

• Parenteral analgesics (e.g. Morphine, Pethidine) to relieve the acute exacerbations of pain
• Condition nearly always resolves over the course of a few hours
• If the dx is confirmed by imaging, subsequent cholecystectomy is usually indicated.