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{{short description|Medical condition in which gallstones cause acute pain}}
{{Infobox medical condition (new)
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<!-- Definition and symptoms -->
'''Biliary colic''', also known as '''symptomatic cholelithiasis''', a '''gallbladder attack''' or '''gallstone attack''', is when a [[colic]] (sudden pain) occurs due to a [[gallstone]] temporarily blocking the [[cystic duct]].<ref name=NIH2013 /> Typically, the pain is in the right upper part of the [[abdomen]], and can be severe.<ref name=NICE2014>{{cite
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Treatment for gallbladder attacks is typically [[cholecystectomy|surgery to remove the gallbladder]].<ref name=NIH2013 /> This can be either done [[laproscopic surgery|through small incisions]] or through a single larger incision.<ref name=NIH2013 /> Open surgery through a larger incision is associated with more complications than surgery through small incisions.<ref name=SBU17 /> Surgery is typically done under [[general anesthesia]].<ref name=NIH2013 /> In those who are unable to have surgery, medication to try to dissolve the stones or [[shock wave lithotripsy]] may be tried.<ref name=NIH2013 /> {{As of|2017|post=,}} it is not clear whether surgery is indicated for everyone with biliary colic.<ref name=SBU17>{{Cite web |url= http://www.sbu.se/en/publications/sbu-assesses/surgery-to-treat-gallstones-and-acute-inflammation-of-the-gallbladder/ |title=Surgery to treat gallstones and acute inflammation of the gallbladder |publisher=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU) |work=SBU.se |access-date=2017-06-01|date=2016-12-16 }}</ref>
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In the [[developed world]], 10
==Signs and symptoms==
Pain is the most common presenting symptom. It is usually described as sharp, crampy, dull or severe right upper quadrant pain, which may
</ref> Nausea and vomiting can be associated with biliary colic. Individuals may also present with pain that is induced following a fatty meal and the symptom of [[indigestion]]. The pain often lasts longer than 30 minutes, up to a few hours.<ref name="Portincasa-2006" /> The pain caused by biliary colic can become so extreme that sufferers may admit themselves to emergency rooms and hospitals to seek treatment. In general, the pain subsides once the gallstone is successfully passed,<ref>{{Cite web |date=2023-11-30 |title=What Causes a Gallbladder Attack? |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/what-causes-a-gallbladder-attack |access-date=2024-01-08 |website=www.hopkinsmedicine.org |language=en}}</ref> but soreness may persist for around 24 hours after the worst of the pain passes.<ref>{{Cite web |date=2019-04-22 |title=Biliary Colic |url=https://www.health.harvard.edu/a_to_z/biliary-colic-a-to-z |access-date=2024-03-09 |website=Harvard Health |language=en}}</ref>
Patients usually have normal vital signs with biliary colic, whereas patients with [[cholecystitis]] are usually febrile and more ill appearing. Lab studies that should be ordered include a complete blood count, [[liver function tests]] and lipase. In biliary colic, lab findings are usually within normal limits. [[Alanine aminotransferase]] and [[aspartate transaminase]] are usually suggestive of liver disease whereas elevation of [[bilirubin]] and [[alkaline phosphatase]] suggests common bile duct obstruction.<ref name="Rosen">{{Cite book |last1=Rosen |first1=Peter |last2=Marx |first2=John A. |title=Rosen's Emergency Medicine: Concepts and Clinical Practice |date=2013 |publisher=Elsevier/Saunders |location=Philadelphia |isbn=978-1-4557-0605-1 |pages=1186–1206 }}▼
Biliary colic can be distinguished from other digestive conditions with similar symptoms, such as indigestion, [[Gastroesophageal reflux disease|gastric reflux]] or [[heartburn]], in that the pain caused by biliary colic is not relieved by vomiting, [[defecation|bowel movements]] or [[flatulence]].<ref name=NHS>{{Cite web |date=2017-10-20 |title=Gallstones |url=https://www.nhs.uk/conditions/gallstones/symptoms/ |access-date=2023-12-11 |website=[[National Health Service]] |language=en}}</ref> The pain is also not affected by changes in posture or [[antacid]] medicine.<ref name=ClevelandClinic>{{Cite web |title=Biliary Dyskinesia: Symptoms, Causes & Treatment |url=https://my.clevelandclinic.org/health/diseases/23932-biliary-dyskinesia |access-date=2023-12-12 |website=[[Cleveland Clinic]] |language=en}}</ref> Episodes of biliary colic are generally intermittent, and sufferers may experience several weeks or months without an attack before experiencing it again.<ref name=NHS></ref>
</ref> [[Pancreatitis]] should be considered if the lipase value is elevated; gallstone disease is the major cause of pancreatitis.▼
▲Patients usually have normal vital signs with biliary colic, whereas patients with [[cholecystitis]] are usually febrile and more ill appearing. Lab studies that should be ordered include a [[complete blood count]], [[liver function tests]] and [[lipase]]. In biliary colic, lab findings are usually within normal limits. [[Alanine aminotransferase]] and [[aspartate transaminase]] are usually suggestive of liver disease whereas elevation of [[bilirubin]] and [[alkaline phosphatase]] suggests common bile duct obstruction.<ref name="Rosen">{{Cite book |last1=Rosen |first1=Peter |last2=Marx |first2=John A. |title=Rosen's Emergency Medicine: Concepts and Clinical Practice |date=2013 |publisher=Elsevier/Saunders |location=Philadelphia |isbn=978-1-4557-0605-1 |pages=1186–1206 }}
▲</ref> [[Pancreatitis]] should be considered if the lipase value is elevated; gallstone disease is the major cause of pancreatitis.{{cn|date=March 2022}}
===Complications===▼
The presence of gallstones can lead to inflammation of the gallbladder ([[cholecystitis]]) or the biliary tree ([[cholangitis]]) or acute inflammation of the pancreas ([[pancreatitis]]). Rarely, a gallstone can become [[Fecal impaction|impacted]] in the [[ileocecal valve]] that joins the [[caecum]] and the [[ileum]], causing [[gallstone ileus]] (mechanical [[ileus]]).<ref name="Portincasa-2006" />▼
Complications from delayed surgery include pancreatitis, [[empyema]], and perforation of the gallbladder, cholecystitis, cholangitis, and obstructive jaundice.<ref name="Duncan" />▼
Biliary pain in the absence of gallstones, known as [[postcholecystectomy syndrome]], may severely
==Causes==
Biliary pain is most frequently caused by obstruction of the [[common bile duct]] or the [[cystic duct]] by a [[gallstone]]. However, the presence of [[gallstones]] is a frequent incidental finding and does not always necessitate treatment, in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the biliary tract, so
Cholesterol gallstone formation risk factors include age, female sex, family history, race,<ref name="Portincasa-2006" /><ref>{{cite journal|last1=Stinton|first1=Laura M.|last2=Shaffer|first2=Eldon A.|title=Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer|journal=Gut and Liver|date=15 April 2012|volume=6|issue=2|pages=172–187|doi=10.5009/gnl.2012.6.2.172|pmid=22570746|pmc=3343155}}</ref> pregnancy, parity, obesity, hormonal [[birth control]], [[diabetes mellitus]], [[cirrhosis]], prolonged [[fasting]], rapid [[weight loss]], [[Parenteral nutrition|total parenteral nutrition]], ileal disease and impaired gallbladder emptying.<ref>{{cite journal |last1=Walton |first1=Thomas J. |last2=Lobo |first2=Dileep N.
Patients that have gallstones and biliary colic are at increased risk for complications, including cholecystitis.<ref name= "Afdhal">{{cite book |last=Afdhal |first=Nezam H. |date=2011 |title=Goldman's Cecil Medicine |edition=24th |location=Philadelphia |publisher=Elsevier/Saunders |
==Diagnosis==
Diagnosis is guided by the person's presenting symptoms and laboratory findings. The [[gold standard (test)|gold standard]] imaging modality for the presence of gallstones is [[ultrasound]] of the right upper quadrant. There are many reasons for this choice, including no exposure to radiation, low cost, and availability in city, urban, and rural hospitals. Gallstones are detected with a specificity and sensitivity of greater than 95% with ultrasound.<ref>{{cite book |editor-last=Fischer |editor-first=J. E. |date=2007 |title=Master of Surgery |edition=5th |location=Philadelphia |publisher=Lippincott Williams & Wilkins}}</ref>{{page needed|date=July 2015}} Further signs on ultrasound may suggest cholecystitis or [[choledocholithiasis]].<ref name="Duncan">{{cite journal |pmid=22986769 |doi=10.1007/s11605-012-2024-1 |volume=16 |issue=11 |title=Evidence-based current surgical practice: calculous gallbladder disease. |date=Nov 2012 |pages=2011–2025 |journal=Journal of Gastrointestinal Surgery |pmc=3496004 |last1=Duncan |first1=C. B. |last2=Riall |first2=T. S.}}</ref> Computed
==Management==
===Medications===
Initial management includes the relief of symptoms and correcting electrolyte and fluid imbalance that may occur with vomiting.<ref name="Rosen" /> Antiemetics, such as [[dimenhydrinate]], are used to treat the nausea.<ref name="Rosen" /> Pain may be treated with anti-inflammatories, [[NSAIDs]] such as [[ketorolac]] or [[diclofenac]].<ref>{{cite journal|last1=Fraquelli|first1=M.|last2=Casazza|first2=G.|last3=Conte|first3=D.|last4=Colli|first4=A.|title=Non-steroid anti-inflammatory drugs for biliary colic.|journal=The Cochrane Database of Systematic Reviews|date=9 September 2016|volume=2016|issue=9|page=CD006390|pmid=27610712|doi=10.1002/14651858.CD006390.pub2|pmc=6457716}}</ref> [[Opioids]], such as morphine, less commonly may be used.<ref name="Rosen2">{{Cite book |last1=Rosen |first1=Peter |last2=Marx |first2=John A. |title=Rosen's Emergency Medicine: Concepts and Clinical Practice |date=2013 |publisher=Elsevier/Saunders |location=Philadelphia |isbn=978-1-4557-0605-1 |pages=223–233}}</ref> NSAIDs are more or less equivalent to opioids.<ref>{{cite journal |
In biliary colic, the risk of infection is minimal and therefore antibiotics are not required.<ref name="Cecil" /> Presence of infection indicates [[cholecystitis]].<ref name="Cecil">{{Cite book |last1=Cecil |first1=Russell L. (Russell La Fayette) |last2=Goldman |first2=Lee |last3=Schafer |first3=Andrew I. |title=Goldman's Cecil Medicine |date=2012 |publisher=Elsevier/Saunders |location=Philadelphia |isbn=978-1-4377-1604-7 |pages=1011–1021}}</ref>
===Surgery===
It is unclear whether those experiencing a gallstone attack should receive surgical treatment or not.<ref name="SBU17" /> The scientific basis to assess whether surgery outperformed other treatment was insufficient and better studies were needed as of a SBU report in 2017.<ref name="SBU17" /> Treatment of biliary colic is dictated by the underlying cause.<ref name="auto">{{
A 2013 Cochrane review found tentative evidence to suggest that early gallbladder removal may be better than delayed removal.<ref name=Guru2013>{{cite journal |last1=Gurusamy |first1=K. S. |last2=Koti |first2=R. |last3=Fusai |first3=G. |last4=Davidson |first4=B. R. |title=Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic |journal=Cochrane Database Syst Rev |volume=6 |issue= 6|page=CD007196 |date=2013 |pmid=23813478 |doi=10.1002/14651858.CD007196.pub3 ▲==Complications==
▲The presence of gallstones can lead to inflammation of the gallbladder ([[cholecystitis]]) or the biliary tree ([[cholangitis]]) or acute inflammation of the pancreas ([[pancreatitis]]). Rarely, a gallstone can become [[Fecal impaction|impacted]] in the [[ileocecal valve]] that joins the [[caecum]] and the [[ileum]], causing [[gallstone ileus]] (mechanical [[ileus]]).<ref name="Portincasa-2006" />
▲Complications from delayed surgery include pancreatitis, [[empyema]], and perforation of the gallbladder, cholecystitis, cholangitis, and obstructive jaundice.<ref name="Duncan" />
▲Biliary pain in the absence of gallstones, known as [[postcholecystectomy syndrome]], may severely impact the patient's quality of life, even in the absence of disease progression.<ref>{{EMedicine|article|192761|Postcholecystectomy Syndrome}}</ref>
==Epidemiology==
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==References==
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== External links ==
{{Medical resources
| DiseasesDB =2533
| ICD10 ={{ICD10|K|80|5|k|80}}
| ICD9 ={{ICD9|574.20}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =med
| eMedicineTopic =224
| MeshID =
}}
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