Biliary colic

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Biliary colic


Peritoneum and peritoneal cavity disorders




Biliary colic


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USMLE® Step 1 questions

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Biliary colic

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USMLE® Step 1 style questions USMLE

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A 42-year-old woman, gravida 3 para 3, is brought to the emergency department due to severe abdominal pain that started 3 hours ago. She describes the pain as sharp, constant, and rates it as 7/10 in intensity. Since the pain started, she has been feeling nauseous and has vomited twice. She reports a few episodes of similar abdominal discomfort in the past but says that this time it “feels different.” Temperature is 38.0°C (100.4°F), pulse is 80/min, and blood pressure is 135/85 mmHg. BMI is 32 kg/m2. The patient is in acute distress due to pain and points to the upper abdomen. The abdomen is tender to touch. No rebound tenderness or hepatomegaly is present. An abdominal ultrasound is performed and reveals a normal common bile duct with concomitant gallbladder wall thickening and free fluid around the gallbladder. Laboratory results are obtained and shown below:  
 Laboratory value  Result 
 Hemoglobin  14 g/dL 
 Leukocyte count  15,000 mm3 
 Platelet count    250,000 mm3 
 Mean corpuscular volume  90 μm3 
 Creatinine   0.8 g/dL 
 BUN  11 mg/dL 
 Total   0.8 mg/dL 
 Direct  0.2 mg/dL 
 Alanine aminotransferase   18 U/L 
 Aspartate aminotransferase   20 U/L 
 Amylase  55 U/L 
 Lipase  62 U/L 
 Alkaline phosphatase   65 U/L 
Which of the following is the most likely diagnosis?

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Biliary colic p. 405


biliary colic p. 405


biliary colic p. 405


“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 its 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.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Symptoms and diagnosis of gallbladder stones" Best Practice & Research Clinical Gastroenterology (2006)
  6. "Evidence-Based Current Surgical Practice: Calculous Gallbladder Disease" Journal of Gastrointestinal Surgery (2012)
  7. "Differences in diet and food habits between patients with gallstones and controls." Journal of the American College of Nutrition (1997)

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