Biliary Colic

What is biliary colic?

Biliary colic is severe pain in your upper abdomen caused by a gallbladder problem. Your gallbladder stores bile, which helps digest (break down) the fats that you eat. Biliary colic happens when something blocks the duct that moves bile out of the gallbladder.

What causes biliary colic?

• Biliary colic may be caused by cholecystitis, which is swelling of the gallbladder. Biliary colic may also be caused by a blockage in either your cystic duct or your bile duct. Your gallbladder contracts to push bile through the blockage, which then causes pain. Most often, the blockage is caused by gallstones that get stuck in your bile or cystic duct. Gallstones are made up of cholesterol, calcium, or bile.
  
  
• Problems in your bile duct may also cause biliary colic. Your duct may become narrow, or there may be a problem with the ring of muscle that enters your small intestine. These problems may happen after surgery to remove your gallbladder. You may get biliary colic after an injury to your gallbladder or bile duct. Other causes include pancreatitis (inflammation of the pancreas), duodenitis (inflammation of the small intestine), or esophageal spasm.

What are the signs and symptoms of biliary colic?

Biliary colic pain is usually felt in the middle of your upper abdomen just below your sternum (breast bone). The pain may last a few minutes or a few hours. Your symptoms may also include any of the following:

• Pain that is worse on your right side, just below your ribs, or pain in your back, just under your shoulder blade
  
  
• Nausea and vomiting
  
  
• Pain after you eat a meal
  
  
• Pain that does not get better when you move around or change your position

What increases my risk of getting biliary colic?

• Family history: Your risk may increase if other members of your family have biliary colic.
  
  
• Long-term fasting or artificial feeding: If you are not able to eat for a long time, or you are fed through a tube, you may have a higher risk of biliary colic.
  
  
• Medical problems:
  
  
  • Hemolytic diseases: These are diseases in which your red blood cells are broken down too quickly.
    
    
  • Liver cirrhosis: This is scarring of your liver. Scarring may be caused by too much alcohol. The liver is the organ in your body that produces bile. The liver also has several other important functions in the body.
    
    
  • Obesity: If you are obese, your risk increases.
  
  
• Medicines: Certain medicines may increase your risk of biliary colic. These include medicines that contain estrogen, such as birth control pills.
  
  
• Older age: As you get older, your risk of biliary colic increases.
  
  
• Pregnancy: Changes in your body when you are pregnant may increase your risk of gallstones and biliary colic.
  
  
• Surgery: Surgery to remove your gallbladder increases your risk. Bariatric surgery (weight loss surgery) increases your risk for gallstones.

How is biliary colic diagnosed?

Your caregiver will ask about your signs and symptoms, and how long you have had them. He may ask about your health history and any medical problems you have. He will ask if you have had previous surgery such as a stent (tube) in your bile duct. He will do a physical exam and may collect samples of your blood and urine for tests. You may also need any of the following tests:

• Abdominal ultrasound: An abdominal ultrasound is a test that shows the inside of your abdomen. Sound waves show pictures of your abdomen on a monitor. Your caregiver may do this test before and after you eat a high-fat meal. This test shows how well your gallbladder is working and if there are any blockages in your biliary system.
  
  
• CT scan:
  
  
  • This is also called a CAT scan. An x-ray machine uses a computer to take pictures of your abdomen to look at the organs and blood vessels in your abdomen, and to check for problems and abnormal changes.
    
    
  • You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregivers see the pictures better. People who are allergic to iodine or shellfish (crab, lobster, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
• Endoscopic ultrasound: An endoscopic ultrasound is also called an EUS. An EUS uses sound waves and an endoscope (small, flexible tube) passed through your mouth to look inside your body. With an EUS, caregivers can see inside your liver, gallbladder, and bile duct.
  
  
• Gastric manometry: Gastric manometry test helps caregivers see if there are problems with how your stomach is working. A small, flexible tube is passed down your throat into your stomach. Pressure readings are taken that may tell your caregiver if there are problems with swallowing or digestion.
  
  
• Magnetic resonance cholangiography: During this test, pictures are taken of your biliary system to check for problems and changes. You will need to lie still during this test. Your caregiver may inject you with a dye, or ask you to drink some juice. The MRI machine contains a very powerful magnet. Never enter the MRI room with any metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
  
  
• Liver and gallbladder scan: This test may also be called a HIDA scan. This is a test to look at your liver and gallbladder. You are given a small amount of radioactive dye in your IV. Pictures are then taken by a special scanner that can "see" the dye in your body. Caregivers look at the pictures to see if your liver and gallbladder are working normally.
  
  
• Abdominal x-rays: Abdominal x-rays are pictures of the organs inside your abdomen. Caregivers use these pictures to look for problems such as blocked or ruptured intestines, kidney stones, or solid masses (tumors) in your organs.

How is biliary colic treated?

Your treatment will depend on how severe your symptoms are. Caregivers may insert an intravenous (IV) tube into a blood vessel. An IV gives you fluids and medicines. You may need any of the following:

• Medicines:
  
  
  • Pain medicine: You may be given medicine to decrease or take away pain. Do not wait until the pain is severe before you take your medicine.
    
    
  • Antibiotics: This medicine will help fight or prevent an infection. Take your antibiotics until they are gone, even if you feel better.
    
    
  • Antispasm medicine: This medicine helps your gallbladder stop contracting, which can decrease your pain.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting.
    
    
  • Oral dissolution therapy: This medicine dissolves your gallstones. You may need oral dissolution therapy if your caregiver thinks surgery may be too risky for you. Only small stones can be dissolved, and it may take many months to work.
  
  
• Procedures: Ask your caregiver for more information about the following procedures:
  
  
  • Biliary drainage: This procedure is also called cholecystotomy. Your caregiver may remove fluid and stones from your gallbladder.
    
    
  • Cholecystectomy: Cholecystectomy is surgery to remove your gallbladder. Based on your symptoms, caregivers may wait to do this surgery, or you may need it right away.
    
    
  • Endoscopic sphincterotomy: You may need this surgery if your biliary colic is caused by a blockage between your bile duct and your intestine. An endoscope is passed through your mouth. The ring of muscle that leads into your small intestine is widened.
    
    
  • ERCP: ERCP is also called endoscopic retrograde cholangiopancreatography. This procedure is done during an endoscopy to find stones, tumors, or other problems. Dye is put into the endoscopy tube. The dye helps your pancreas and bile ducts show up better on x-rays. If you have stones, they may be removed during ERCP. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines.
    
    
  • Laparoscopic common bile duct exploration: A laparoscope (flexible tube with a camera on the end) is put into your abdomen. Your caregiver looks at your biliary system, and may remove stones.
    
    
  • Lithotripsy: Shock waves break apart stones in your gallbladder. You may be placed in a water bath or on a water-filled cushion. Medicine may be used to keep you drowsy during the procedure. Shock waves are sent through the water and toward the stone or stones. The stones may break apart when the shock waves hit them.
    
    
  • Stenting: This surgery puts a stent into your bile or cystic duct to keep it open.

What are the risks of treating or having biliary colic?

• Medicine used to treat your pain may cause dizziness, nausea, vomiting, sleepiness, or a rash. Medicine or shock wave treatment to break down your gallstones may leave bits of the stones in your body. These bits of stone may block your ducts again. During surgery, your bile duct or nearby organs such as your intestine may be damaged. Bile may leak into your abdomen. Even after treatment, stones may remain, or reform, in your ducts and block them again.
  
  
• Without treatment, your pain may come back, and your pain may get worse over time. You may have jaundice (yellow skin and eyes). If a gallstone is in your gallbladder, it may pass into your bile duct and cause a blockage. You may get an infection in your gallbladder or bile duct from the blockage. A gallstone may go into your intestine and cause a bowel obstruction. You may also develop problems in your other organs, such as inflammation of your pancreas. These infections, blockages, and inflammation can make you very sick, and you may die. Talk to your caregiver if you have any questions or concerns about your condition, treatment, or care.

What can I do to help prevent biliary colic?

• Avoid alcohol: Alcohol can damage your liver and increase your risk for getting biliary colic. Tell your caregiver if you drink alcohol. Ask him for information on how to stop if you need help.
  
  
• Maintain a healthy weight: If you are overweight, you may increase your risk of gallstones, which can cause biliary colic. Ask your caregiver how to lose weight slowly and safely. Do not try to lose a lot of weight very quickly. Too much weight lost quickly may also increase your risk of gallstones.
  
  
• Exercise: Exercise may help prevent gallstones and biliary colic. Talk with your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger.
  
  
• Eat healthy foods: Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat, and fish. Foods that are high in fiber and low in fat and cholesterol may reduce your risk of gallstones. Nuts may also reduce your risk. Ask your caregiver if you need to be on a special diet.

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You feel dizzy or sleepy, or you have a rash.
  
  
• You are vomiting or have nausea.
  
  
• Your urine is dark, or your bowel movements are light gray.
  
  
• Your pain lasts longer than before or is happening more often.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your skin or eyes are yellow.
  
  
• You have trouble staying awake, or you feel like you are going to lose consciousness.
  
  
• You have strong pain in the right side of your abdomen.
  
  
• You have shortness of breath or pain when you take a deep breath.
  
  
• Your pain suddenly gets worse and comes more often than before.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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