Biliary colic is caused by gallstones passing through the biliary tree.

Risk factors

• it is traditional to refer to the '4 F's':
  • Fat: obesity is thought to be a risk factor due to enhanced cholesterol synthesis and secretion
  • Female: gallstones are 2-3 times more common in women. Oestrogen increases activity of HMG-CoA reductase
  • Fertile: pregnancy is a risk factor
  • Forty
• other notable risk factors include:
  • diabetes mellitus
  • Crohn's disease: primarily due to Ileal involvement or resection
  • rapid weight loss e.g. weight reduction surgery
  • drugs: fibrates, combined oral contraceptive pill

Pathophysiology

• occur due to ↑ cholesterol, ↓ bile salts and biliary stasis
• the pain occurs due to the gallbladder contracting against a stone lodged in the cystic duct

Features

• colicky right upper quadrant abdominal pain
  • worse postprandially, worse after fatty foods
  • the pain may radiate to the right shoulder/interscapular region
• nausea and vomiting are common
• in contrast to other gallstone-related conditions, in biliary colic there is no fever and liver function tests/inflammatory markers are normal

Investigation

• ultrasound

Management

• elective laparoscopic cholecystectomy
• complications of cholecystectomy
  • early: bleeding, bile leak (pain, fever, bilious drainage from a surgical drain), infection, injury to bile ducts
  • late: postcholecystectomy syndrome - a complex of heterogeneous symptoms, including persistent abdominal pain and dyspepsia. Many biliary and extrabiliary factors can contribute to this

Around 15% of patients are found to have gallstones in the common bile duct (choledocholithiasis) at the time of cholecystectomy, This can result in obstructive jaundice in some patients

Possible complications other than biliary colic

• acute cholecystitis: the most common complication
• ascending cholangitis