Biliary Colic

Biliary Colic

What Is Biliary Colic?

By Dr. Lee Ser Yee
Pain in the upper abdomen due to gallbladder issues is known as biliary colic.

This symptom arises as a result of gallstone blockage in the gallbladder or cystic duct, a tube that carries bile from the gallbladder into the small intestine. The main cause of biliary colic is the formation of gallstones, which are stone-like masses composed of cholesterol, calcium and bilirubin, in the gallbladder. It can also be caused by gallbladder polyps or functional disorders of the gallbladder (Biliary dyskinesia).

Typically, biliary colic symptoms include pain in the middle or upper right abdominal region that may extend to the shoulder area and upper back. The pain can be sharp, stabbing, squeezing or intense, and may last from a few minutes to a few hours due to swelling and pressure within the gallbladder. This can be associated with bloatedness, indigestion, discomfort, nausea or vomiting as well, especially after heavy fatty meals.

How Is Biliary Colic Diagnosed?

A gallbladder surgeon conducts several diagnostic tests to determine the cause of biliary colic. This condition is commonly diagnosed with an ultrasound. During this test, sound waves are used to produce images from within the abdomen and determine the presence, location, and number of gallstones and any evidence of gallbladder inflammation/infection. In some cases, other imaging tests may be needed to diagnose this condition and exclude other possible conditions, such as computed tomography (CT scan) and magnetic resonance imaging (MRI).

What Are the Risk Factors of Biliary Colic?

People may be at a higher risk of developing gallstones that lead to biliary colic based on these factors:

  • The condition develops more frequently in women than in men due to the estrogen hormone, which increases the likelihood of gallstone formation.
  • Having a family history of gallstones makes an individual more prone to developing gallbladder issues.
  • Gallstones occur more frequently in people over the age of 40.
  • A person who is overweight or obese is likely to have a higher level of cholesterol in their bile, which may contribute to stones forming. Fasting and sudden weight loss can also affect bile cholesterol levels and imbalance in the bile constituents.

What Are the Treatments for Biliary Colic?

The most effective method of treating biliary colic is the removal of gallbladder and the gallstones within via surgery, known as cholecystectomy. This can be performed through laparoscopic or open surgery:

  • Laparoscopic Surgery - This minimally-invasive procedure involves creating small incisions on the abdomen through which a camera (laparoscope) and surgical instruments are inserted to remove the gallbladder. Benefits include lesser pain, small scars and a faster recovery.
  • Open Surgery - This procedure is usually undertaken when the gallbladder is severely inflamed or if conditions are not suitable or safe for the laparoscopic approach e.g., previous surgery. Here, the surgeon creates an incision of 10-15cm in the abdomen for gallbladder removal.

There is no effective medicines or medical treatment for biliary colic or symptomatic gallstones.

Risks of Biliary Colic

When the bile ducts are obstructed for a long period, serious complications may occur such as:

  • Infected or swollen (inflamed) gallbladder (Acute cholecystitis)
  • Damaged and infected bile ducts or liver (e.g., Cholangitis, jaundice, liver abscesses)
  • Long term infection/inflammation of the gallbladder (Chronic cholecystitis) leading to an increased risk of gallbladder cancer
  • Inflamed pancreas (gallstone pancreatitis)

Hence, should you experience symptoms of biliary colic, do not hesitate to seek early medical attention to obtain an accurate diagnosis and embark on a proper treatment plan.

“Keyhole (laparoscopic) removal of the gallbladder together with the gallstones within is the safe, effective and the current gold standard treatment for the condition. It is a relatively common and straightforward procedure in trained hands and most patients can go home on the day itself with minimal pain and discomfort.”