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Biliary colic

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Biliary colic

  1. 1. Biliary colic is a condition characterized by extreme cramping pain in the right upper abdomen. Gallstones in the gallbladder (small, pear-shaped sac under the liver that stores bile), or in the bile ducts (small tubes that drain bile from the liver into the gallbladder and small intestines) are the cause of the severe pain. About one third of patients with gallstones develop biliary colic or other complications. People who are overweight or have a high level of blood cholesterol increase their risk of developing gallstones and biliary colic. Pregnant women, or those on birth control pills or estrogen replacement therapy also have a greater risk of developing biliary colic. Other risk factors include rapid weight loss, diabetes, certain gastrointestinal conditions and certain medications. Biliary colic is caused by gallstones that form in the gallbladder or bile ducts. Gallstones form when bile, a substance made in the liver to help digest fats, contains too much cholesterol. A solid particle forms and becomes a gallstone. Symptoms A) Abdominal Pain characteristics 1) Right Upper Quadrant Abdominal Pain or Epigastric Abdominal Pain 2) Dull visceral ache 3) Poorly localized discomfort 4) Pain radiates to right posterior shoulder or scapula B) Abdominal Pain timing:
  2. 2. 1) Occurs suddenly 30-60 minutes after a meal - Normal meal - Large meal after a fast - Fatty meal 2) Increasing frequency and intensity of attacks 3) Pain lasts for 1-6 hours 4) Intermittent "colicky" exacerbations of pain 5) Mild abdominal aching for 1-2 days after attack C) Associated symptoms 1) Nausea and Vomiting 2) No Fever or chills Signs - Right Upper Quadrant abdominal tenderness - No signs of peritoneal irritation - Dehydration from protracted Vomiting - Patient is diaphoretic, pale, rolling about, and unable to get comfortable - Sinus tachycardia is common during pain. Differential Diagnosis - Acute Cholecystitis- Fever and chills frequently present
  3. 3. - Cholangitis- Charcot's Triad –Fever, Jaundice, Right Upper Quadrant pain & Reynold's Pentad- Charcot's Triad , Shock and Altered mental status - Pancreatitis- Low grade fever, Cullen's Sign (periumbilical discoloration) & Turner's Sign (flank discoloration) Labs - Complete Blood Count usually normal - Mild elevation of Liver Function Tests a) Bilirubin slightly elevated b) Alkaline Phosphatase slightly elevated - Pancreatic enzyme tests normal a) Amylase normal b) Lipase normal - Urinalysis normal Radiology - XRay Abdomen - low Sensitivity - Abdominal ultrasonography - Oral cholecystography - Hepatobiliary (hepatoiminodiacetic acid) scintigraphy - Magnetic resonance cholangiopancreatography - Endoscopic retrograde cholangiopancreatography (ERCP) Management
  4. 4. 1) Laparoscopic Cholecystectomy - Preferred option 2) Antispasmodic - Glycopyrrolate (Robinul) - Parenteral: 0.1 to 0.2 mg IV or IM - Oral: 1.0 to 2.0 mg PO bid-tid 3) Analgesic - Meperidine (Demerol) opioid analgesic - 50-150 mg PO/IV/IMLess sphincter of Oddi spasm than morphine - Ketorlac (Toradol)- 30-60 mg IM initially, followed by 15-30 mg q6h Relieves pain of gallbladder distention 4) Antiemetics - Metoclopramide (Reglan)- 10 mg IV q6h 5) Nasogastric Suction - Indicated for protracted Vomiting 6) Alternatives in non-surgical candidates - Bile Acid Oral Dissolution Therapy- Treatment Protocol: Ursodiol (Actigal) - Dose: 8-10 mg/kg/day PO divided bid to tid - Course: 6-12 months

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