Biliary colic

Q: Biliary colic pain is usually? (select one)

A) constant

B) spasmodic

Answer: A

Biliary colic is a misnomer. Biliary pain is usually constant. This misnomer occurs as biliary pain tends to be very intense and provides no relief with movement, squatting, bowel movements, or flatus. Probably due to eventual smooth muscle fatigue or stone passage, the attack typically lasts for about 30 minutes, plateaus at 60 minutes, and slowly subsides within 6 hours. It occurs at the right upper quadrant (RUQ), epigastrium, or sometimes at the substernal area. It may radiate to the back with a tendency towards the right shoulder blade. Associated symptoms are diaphoresis, nausea, and vomiting.

Typically (though not necessary), it is postprandial pain, after a fatty meal.

The acute attack is not associated with fever, tachycardia, lab abnormality, or any peritoneal signs except voluntary guarding. The majority of patients have a recurrence of attack within two years.

#physical-exam

#hepatology

References:

1. Diehl AK, Sugarek NJ, Todd KH. Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis. Am J Med 1990; 89:29.

2. Festi D, Sottili S, Colecchia A, et al. Clinical manifestations of gallstone disease: evidence from the multicenter Italian study on cholelithiasis (MICOL). Hepatology 1999; 30:839.

3. Thistle JL, Cleary PA, Lachin JM, et al. The natural history of cholelithiasis: the National Cooperative Gallstone Study. Ann Intern Med 1984; 101:171.