Biliary colic: Difference between revisions

'''Biliary colic''' is the clinical manifestation of uncomplicated [[gallstone disease]]. It refers to recurrent attacks of severe pain of typical character. It is not dangerous, but it is bothersome. Treatment involves avoidance of fatty foods and analgesics during attacks. The only definitive treatment is cholecystectomy.

In uncomplicated gallstone disease, there are no elevated inflammatory parametres or signs of cholestasis (elevated ALP/GGT or bilirubin), and no fever. Ultrasound can show the presence of [[Gallstone disease|cholelithiasis]], but imaging is not necessary for the diagnosis if the clinical features are typical and complicated gallstone is ruled out.

Biliary colic itself is not an indication for surgery, unless the patient has many episodes of them. In many cases, patients can live with these attacks if they're rare enough and not that severe (or painkillers have sufficient efficacy).The only definitive way to prevent episodes is cholecystectomy.

Analgesia during the attacks is important. The first choice is NSAIDs like ketorolac, diclofenac, or ibuprofen, and the second choice is opioids like morphine. Many are reluctant to use morphine as it theoretically contricts the sphincter of Oddi, and alternative opioids which cause less constriction (like buprenorphine or meperidine) are often used instead. However, systematic reviews have found that all opioids cause sphincter constriction, and there is no evidence that morphine is worse than other opioids in this regard.

Peripheral anticholinergics like butylscopolamine/hyoscine (Buscopan®) can reduce the biliary spasm and improve the pain when combined with NSAIDs.