Biliary colic

Biliary colic: Introduction

Biliary colic pain usually occurs after eating fatty food and lasts for a few hours. Patients with biliary colic do not appear as sick as patients with acute choecystitis. But, there is significant overlap in the symptoms of biliart colic and acute cholecystitis. Pain of biliary colic is the result of overdistension of the gall bladder as it tries to cintract in the presence of partial or complete obstruction at the level of the neck of gall bladder.

Biliary Colic: A forty year old female with “gas pain”

Mrs D is a mother of 4 little kids. She is a stay home mom taking care of the kids and the house. She loves to cook and she bakes the most delicious cookies in her neighborhood. She is slightly overweight but does not appear very big. She has not had any major medical problems in the past. She gets her annual pap smear every year and has always been normal. She tries to take care of herself the best she can. Her husband works in the local bank and they are financially well off.

For the last six months, Mrs D has had several episodes of pain lasting for a few hours at a time. She has noticed that the pain usually occur after meals. They start slowly about 20 minutes after her meal. She feels like her stomach gets bloated as the pain starts. She normally takes a Gas-x pill thinking the pain to be a gas pain. Sometimes it helps, sometimes it does not. As it started happening almost once or twice a week, she noticed that there were certain types of food that would produce the symptoms almost every time she ate those foods. She learned that deep fried foods and foods rich in butter did not agree with her. She slowly modified her diet and the pain seem to go away for a while. In fact she had not had any pain for more than two months until the day she had the bad attack.

They had some guests at their house that day. She was cooking their favorite butter chicken recipe.  She had not had such a nice and tasty meal in a while as she was avoiding butter altogether. That day, she decided to go ahead and indulge herself with the butter chicken. She was scare the pain would come back but she knew it had been a while and she thought maybe her stomach has been healed by now. But, just about half an hour into the meal, she started to get a very bad pain. It started as a gassy bloating but slowly   progressed into a bad pain. She had to excuse herself from the guests and had to lie down in her bed. Her husband was very concerned. The guests left early but she continued to have the pain. She started to get somewhat nauseated and she threw up the chicken. She felt sick and her husband drove her to the ER.

In the ER, she had some blood work done. The ER doctor could not immediately decide if the pain was just biliary colic or acute cholecystitis. She needed further work-up and advised that she be observed in the hospital overnight. As the on-call admitting doctor, I was in charge of her observation. I reviewed her blood work. It was mostly within normal limits. She had a distinct tenderness in the right upper part of her abdomen which can happen in both biliary colic and acute cholecystitis. But the lack of fever and normal blood work pointed more towards biliary colic than acute cholecystitis. I started the patient on some iv fluids and pain medications. Her symptoms resolved in six hours. I ordered an ultrasound of the abdomen in the morning. The ultrasound showed small stones inside her gall bladder but the gall bladder itself appeared normal. This confirmed the diagnosis of biliary colic. As she was pain free, we gave her a normal diet. She tolerated it well without ant problems. She was then discharged home. She was given a follow up appointment with the general surgeon. She would need the gall bladder taken out in a few days if she wanted to get rid of her pain once and for all. Most patients with biliary colic are cured by the surgery but a small percentage of patients with biliary colic may develop complications. Some patients initially diagnosed with biliary colic actually end up having acute cholecystis. Doctors, therefore, use caution when diagnosis biliary colic. When the distinction between biliary colic and acute cholecystitis is not very clear, they err on the side of caution and treat the patient as if they had acute cholecystitis instead of just biliary colic.

I hope the story of Mrs D helped you understand more about biliary colic. Please check back soon as I will be uploading more stories about different aspects of patients with biliary colic and other gall bladder symptoms.

Thank You

Nabin Sapkota, MD