Biliary colic

“Colic” refers to severe abdominal pain, and “biliary” refers to the bile ducts; biliary colic happens when gallstones get lodged in the bile ducts, which causes temporary severe abdominal pain.

Sometimes this is also called a “gallbladder attack” because it can come on pretty quick. When you eat foods that’re high in fat, like delicious french fries, they make their way to the small intestine, and the fatty acids in the fries stimulate cells which are the enteroendocrine cells or hormone secreting cells of the intestine.

These cells secrete cholecystokinin (also called CCK) into the bloodstream, and those hormones make their way to the gallbladder and tell it to squeeze.

Meanwhile CCK relaxes the sphincter of Oddi so that the bile can make it’s way to the duodenum. Now, bile’s a fat emulsifier, essentially helping to break fats or lipids into small “micelles”, and then pancreatic lipase gets in there and helps with break it down into even smaller molecules, which can then be absorbed by the villi of the small intestine.

Now, some people develop gallstones, which are hard stones that form in the gallbladder and are made up of the components of bile.

Risk factors for developing gallstones include things like female sex, obesity, pregnancy, and age, sometimes remembered by the 4 F’s—female, fat, fertile, and forty.

Now, after having a meal, that gallbladder might contract and eject the gallstone into the cystic duct, where it gets lodged.

As the gallbladder contracts against the lodged gallstone, it can cause sudden, DULL pain in the right upper quadrant or epigastrium which can then radiate to the right shoulder.

Typically, the pain intensity increases for about 15 minutes, then hits a steady plateau for a few hours, but usually less than about 6 hours, at which point the gallstone dislodges and rolls back into the gallbladder and the pain subsides.

The pain often starts up several hours after a meal, but can also happen frequently at night, since laying flat might make it easier for a gallstone to get lodged in the cystic duct.

Other symptoms include nausea, vomiting, and sweating. So biliary colic’s where that pain’s temporary, but if the gallstone doesn’t dislodge and stays in the cystic duct for longer stretches, it can lead to acute cholecystitis or inflammation of the gallbladder, which can cause similar symptoms like pain in the right upper quadrant, but since there’s also a significant amount of inflammation, there are more severe symptoms like fever.

Diagnosis of biliary colic is typically based on recurrent symptoms and confirmed by ultrasound of the right upper quadrant.

Treatment involves managing pain and other symptoms, but the definitive treatment of recurrent biliary colic is a cholecystectomy, removal of the gallbladder.

Alright, as a quick recap, with biliary colic, usually a gallstone gets lodged in the cystic duct following a fatty meal, which tends to cause a steady DULL upper right quadrant pain for a few hours which then subsides when the gallstone dislodges.