Biliary colic refers to inflammation of the gallbladder caused by stones formed there. Patients suffer from pressure and inflammatory pain, and often febrile accompanying illnesses that can result from the body’s defensive response to the internal inflammation of biliary colic.
What is biliary colic?
Schematic diagram showing the anatomy and structure of the gallbladder with gallstones. Click to enlarge. Biliary colic is most often diagnosed after the onset of severe pain in the upper abdomen, but which may radiate to other parts of the body. It is caused by gallstones formed in the gallbladder before the first symptoms appear, which often obstruct the natural activity of the gallbladder after a fatty meal in such a way that inflammation occurs. The obstruction of this process, in which the gallbladder tries to pump bile into the stomach for digestion and can be blocked by the stones, causes severe irritation and sudden pain. Stones that have rubbed against each other in the gallbladder for a long time and thus irritated the gallbladder can also trigger biliary colic, which in this case becomes chronic if not treated quickly. If one of the stones slips into the outlet of the gallbladder and thus blocks the activity of the organ, biliary colic is also triggered. Often, biliary colic is also accompanied by inflammatory reactions such as chills, fever or, in some cases, even a yellowing of the skin.
Causes
Biliary colic caused by formed gallstones can have several causes. Once stones have formed, there is an increased risk of developing biliary colic. It is not known exactly when and why these gallstones form, so in principle anyone can be affected by biliary colic. However, people who eat an irregular diet and thus prevent regular stress and kneading of the gallbladder seem to be particularly susceptible. The likelihood of gallstones forming and thus the risk of developing biliary colic increases in this case.
Symptoms, complaints and signs
Biliary colic may present with sudden severe [[[upper abdominal pain|pain in the upper abdomen]], but it may also announce itself slowly with a nonspecific feeling of pressure and fullness in the upper abdomen. The pain may be felt under the right costal arch or in the middle of the abdomen, and it may radiate down the right side into the back and shoulder. Characteristic of biliary colic is that the pain usually comes and goes in waves, similar to labor pains, which they also resemble in severity. The colic is caused by the gallbladder and bile duct contracting to expel the blocking gallstone. The severe pain causes sufferers to urge themselves to move in order to relieve the pain. Exercise is also useful because it can help expel the gallstone. The duration of biliary colic can range from 15 minutes to several hours. In addition to severe pain, other symptoms may include gas, bloating, belching, nausea and vomiting. Biliary colic can recur as long as gallstones are present in the gallbladder. Sometimes only surgical removal of the gallstone or gallbladder will help in the long run if many small gallstones are present in the gallbladder.
Course
Depending on how biliary colic was first triggered, the symptoms may subside again or persist chronically. For example, if high-fat food was the trigger, the pain may be relieved once the bile has been completely pumped into the stomach and the gallbladder has stopped contracting. However, if a patient has been suffering from larger gallstones for some time, which cause inflammation or obstruction of the gallbladder and thus biliary colic due to attrition, the stones must be removed as soon as possible.
Complications
Acute biliary colic can lead to various complications and sequelae. First, there is a risk that the accumulated bile will leak and enter the abdomen. Such gallbladder perforation can lead to severe inflammation of the internal organs and, in extreme cases, cause life-threatening sepsis.The gallbladder itself can also become inflamed and trigger what is known as cholecystitis. In this case, the gallstones rub against each other and cause severe pain in the upper abdomen and sometimes gallbladder empyema. Chronic cholecystitis can promote gallbladder carcinoma, which is associated with jaundice, unwanted weight loss and the typical symptoms of biliary colic. Complications can also arise during the treatment of biliary colic. For example, the painkillers and spasmolytics used can cause a number of side effects such as allergic reactions and eye pain or headaches. In combination with other medications (for example, the anticancer and antirheumatic drug methotrexate), the prescribed preparations can cause interactions. Injuries to the gallbladder may occur during surgical removal of gallstones. If the gallbladder itself is removed, there may be temporary metabolic disturbances, but these should subside after a few days to weeks.
When should you see a doctor?
If there is sudden severe pain in the chest or stomach area, see a doctor immediately. This is an acute condition of the body for which immediate help is needed. If cramp-like discomfort occurs in the right side of the body, a doctor is needed to initiate an examination and treatment. The middle and upper abdomen are the regions that stand out due to unexpected attacks of pain and need to be examined by a medical professional. If there is a blockage of bowel activity, medical attention is also necessary. If the affected person suffers from very severe symptoms, an emergency physician should be called. To avoid further complications, the patient should remain calm until the ambulance arrives. In addition, the instructions of the ambulance service should be followed. In case of symptoms such as vomiting, diarrhea, chills or nausea, a doctor should be consulted. Fever or a general feeling of illness are signs that must be controlled and medically clarified. In most cases, there is an improvement in health within a few days of medical care. If this does not occur, a further control examination is necessary. If the bile pain occurs at repeated intervals, this is considered unusual. It is advisable to work with a gastroenterologist to determine the cause.
Treatment and therapy
There are several options for treating biliary colic, depending on what caused the colic and how large the gallstones are. Stones smaller than five millimeters can be treated by administering dissolving medications that contain artificial bile acid. If the treatment is effective, the biliary colic subsides as the stones recede and dissolve. Stones that have slipped into the connecting duct to the stomach must be removed as soon as possible, usually using an endoscope inserted through the stomach. However, this treatment option is only possible if the biliary colic was caused by a blockage and the stone can be reached by probe. If the stones are located in the gallbladder and are too large to be dissolved by medication, it is also possible to treat biliary colic by surgically removing the gallbladder. This methodology is also advised in cases of severe suppuration or infection, as in these cases it is assumed that even if the biliary colic resolves, it is likely to re-inflame within a few years. The procedure can be performed either through an incision in the abdominal wall, or through a small puncture, the so-called buttonhole method. Those who do not wish to undergo surgery have the option of having larger stones broken up by external ultrasound wave treatment and using medication to dissolve the fragments and treat biliary colic in this way.
Outlook and prognosis
The prognosis for biliary colic depends on the causative reason for the symptoms, the size of existing gallstones, and their location. In principle, the patient has a good prognosis when seeking medical treatment. This deteriorates as soon as inflammation develops or treatment is refused. In severe cases, the patient is even threatened with a life-threatening condition.In the case of small gallstones, medication can relieve the symptoms within a few days. The drugs cause the stones to regress and dissolve. Subsequently, the patient is considered free of symptoms after a few weeks. In the case of larger gallstones or foreign bodies that are difficult to access, removal is performed in a surgical procedure. This procedure is associated with the usual risks and side effects. If no complications occur, the patient can also be discharged from the treatment as cured after a few weeks. In the case of large stones or gallstones located directly in the gallbladder, surgical removal of the gallbladder may be required. This procedure is comparatively more extensive and involves greater consequences. Nevertheless, there is a good prognosis in this case as well. As an alternative to surgery, the patient may opt for ultrasound treatment followed by drug therapy. With this treatment plan, there is an equally good chance of cure.
Prevention
Those with acute symptoms of biliary colic can prevent inflammation by eating a low-fat, low-impact diet. People with gallstones also often take bile acid-containing medications as a preventive measure to thin the bile and thus prevent biliary colic.
Follow-up care
As part of follow-up care, regular progress monitoring by the physician is recommended. During these follow-up visits, the physician will, among other things, inquire about dietary habits and, if necessary, make suggestions for changes. Basically, the diet must be changed. A diet low in saturated fatty acids and rich in polyunsaturated fatty acids is considered ideal. The patient should maintain close contact with a nutritionist during follow-up and constantly adjust the diet to the symptom picture. Follow-up care may also include the use of alternative remedies. Various medicinal plants with a choleretic effect have an antispasmodic effect on the bile ducts and contribute to an improvement in symptoms. For example, the patient can try peppermint, turmeric, dandelion or wormwood. In any case, the use of natural remedies should be monitored by a doctor so that any side effects can be detected early. After biliary colic, follow-up examinations must take place every three to six months. If there are no further symptoms, the intervals can be gradually increased. During follow-up examinations, blood values are measured, among other things, and ultrasound examinations are performed if necessary. In addition, the physician will always take a medical history to better assess the course of the disease.
What you can do yourself
Biliary colic should be medically clarified in any case. In most cases, medical treatment can be supported by simple measures and various home remedies. In the case of regular bilious complaints, a change in diet is recommended. Fatty or highly sugared foods are a frequent trigger for colic and should be avoided for the time being. A balanced diet with fruit, vegetables, whole grain products and lean meat and fish is healthier. As a general rule, eat slowly and drink enough water at each meal. Snacking while standing up should be avoided. Dietary measures also help against obesity and high cholesterol levels – both possible causes of biliary colic. Symptomatically, colic can be treated with various medicinal plants. Artichoke reduces flatulence and bloating, while psyllium, fenugreek and garlic relieve abdominal cramps. Immediately after eating, acute discomfort can be prevented with herbal teas (such as those made from turmeric, caraway or celandine) and hot abdominal compresses. If, despite these measures, the symptoms are severe, the bile colic must be taken to a doctor. It is possible that the symptoms are caused by a medication or that there is a serious underlying condition that needs to be treated immediately.
