1. Biliary colic is a condition characterized by extreme cramping pain
in the right upper abdomen. Gallstones in the gallbladder (small,
pear-shaped sac under the liver that stores bile), or in the bile ducts
(small tubes that drain bile from the liver into the gallbladder and
small intestines) are the cause of the severe pain.
About one third of patients with gallstones develop biliary colic or
other complications. People who are overweight or have a high
level of blood cholesterol increase their risk of developing
gallstones and biliary colic. Pregnant women, or those on birth
control pills or estrogen replacement therapy also have a greater risk
of developing biliary colic. Other risk factors include rapid weight
loss, diabetes, certain gastrointestinal conditions and certain
medications.
Biliary colic is caused by gallstones that form in the gallbladder or
bile ducts. Gallstones form when bile, a substance made in the liver
to help digest fats, contains too much cholesterol. A solid particle
forms and becomes a gallstone.
Symptoms
A) Abdominal Pain characteristics
1) Right Upper Quadrant Abdominal Pain or Epigastric Abdominal
Pain
2) Dull visceral ache
3) Poorly localized discomfort
4) Pain radiates to right posterior shoulder or scapula
B) Abdominal Pain timing:

2. 1) Occurs suddenly 30-60 minutes after a meal
- Normal meal
- Large meal after a fast
- Fatty meal
2) Increasing frequency and intensity of attacks
3) Pain lasts for 1-6 hours
4) Intermittent "colicky" exacerbations of pain
5) Mild abdominal aching for 1-2 days after attack
C) Associated symptoms
1) Nausea and Vomiting
2) No Fever or chills
Signs
- Right Upper Quadrant abdominal tenderness
- No signs of peritoneal irritation
- Dehydration from protracted Vomiting
- Patient is diaphoretic, pale, rolling about, and unable to get
comfortable
- Sinus tachycardia is common during pain.
Differential Diagnosis
- Acute Cholecystitis- Fever and chills frequently present

3. - Cholangitis- Charcot's Triad –Fever, Jaundice, Right Upper
Quadrant pain & Reynold's Pentad- Charcot's Triad , Shock and
Altered mental status
- Pancreatitis- Low grade fever, Cullen's Sign (periumbilical
discoloration) & Turner's Sign (flank discoloration)
Labs
- Complete Blood Count usually normal
- Mild elevation of Liver Function Tests
a) Bilirubin slightly elevated
b) Alkaline Phosphatase slightly elevated
- Pancreatic enzyme tests normal
a) Amylase normal
b) Lipase normal
- Urinalysis normal
Radiology
- XRay Abdomen - low Sensitivity
- Abdominal ultrasonography
- Oral cholecystography
- Hepatobiliary (hepatoiminodiacetic acid) scintigraphy
- Magnetic resonance cholangiopancreatography
- Endoscopic retrograde cholangiopancreatography (ERCP)
Management

4. 1) Laparoscopic Cholecystectomy - Preferred option
2) Antispasmodic
- Glycopyrrolate (Robinul)
- Parenteral: 0.1 to 0.2 mg IV or IM
- Oral: 1.0 to 2.0 mg PO bid-tid
3) Analgesic
- Meperidine (Demerol) opioid analgesic - 50-150 mg PO/IV/IMLess sphincter of Oddi spasm than morphine
- Ketorlac (Toradol)- 30-60 mg IM initially, followed by 15-30 mg
q6h
Relieves pain of gallbladder distention
4) Antiemetics
- Metoclopramide (Reglan)- 10 mg IV q6h
5) Nasogastric Suction - Indicated for protracted Vomiting
6) Alternatives in non-surgical candidates - Bile Acid Oral
Dissolution Therapy- Treatment Protocol: Ursodiol (Actigal)
- Dose: 8-10 mg/kg/day PO divided bid to tid
- Course: 6-12 months