Biliary colic

Biliary colic is one of the symptoms of gallstones. The cause of colic is a stone that blocks the bile duct and prevents the normal outflow of bile, colic can also be provoked by muscle spasm due to irritation of a dense accumulation of stones in the organ.

An attack can be caused by poor nutrition (fatty, spicy, alcoholic), as well as severe nervous or physical stress.

Acalculous biliary pain, which occurs in the absence of gallstones, is associated with structural or functional abnormalities and sometimes requires laparoscopic cholecystectomy.

ICD 10 code

According to ICD-10, biliary colic belongs to the class of gallbladder diseases (K-80 – cholelithiasis).

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Causes of biliary colic

Biliary colic may occur in the absence of gallstones, especially in young women. Up to 15% of laparoscopic cholecystectomies are performed for this condition. Common causes include the presence of microscopic stones, impaired gallbladder motility, an overly sensitive biliary tract, dysfunction of the sphincter of Oddi, hypersensitivity of the adjacent duodenum, and possibly gallstones that spontaneously pass. Some patients may develop other functional gastrointestinal disorders.

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Symptoms of biliary colic

Characteristic symptoms of biliary colic include severe pain on the right side, in some cases it can radiate to the back, neck or cover the entire abdominal area.

Most often, the attack begins at night, the pain intensifies when inhaling or if the patient lies on the left side (some relief comes from lying on the right side with the legs pulled up to the stomach).

During an attack of colic, a person suffers from frequent vomiting, which usually does not bring relief, the skin becomes pale, with a yellowish tint, the abdomen becomes bloated, and when pressed, sharp pain and muscle spasm are felt.

During attacks, body temperature is usually elevated, feces become colorless, and urine becomes dark.

An attack can last from 5-7 minutes to 2-3 days; doctors classify this condition as one that requires immediate medical attention.

Biliary-Biliary colic is considered the main symptom of gallstone formation. Attacks are characterized by severe pain caused by muscle spasm due to the presence of a foreign body (stones).

Diagnosis of biliary colic

Acalculous pain syndrome is suspected in patients with biliary colic if the investigation does not reveal gallstones. Investigations include ultrasound and endoscopic ultrasound. Cholescintigraphy after cholecystokinin administration is performed to assess the evacuation function of the gallbladder (ejection fraction) (avoid the use of drugs that potentially affect the result, such as calcium channel blockers and anticholinergics). ERCP with biliary manometry is performed to detect sphincter of Oddi dysfunction. An endoscopic barostat test is performed to detect duodenal hypersensitivity, but this test is only performed in specialized centers.

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Treatment of biliary colic

Laparoscopic cholecystectomy improves outcomes in microscopic stones and possibly in gallbladder motility disorders. The ability to predict the effectiveness of laparoscopic cholecystectomy in treating such disorders is being clarified by other studies.

Severe pain during an attack of biliary colic is relieved by antispasmodic drugs (usually in the form of injections) - papaverine, no-shpa, atropine.

For severe pain, a novocaine blockade is used.

Treatment of inflammation of the gallbladder is mainly surgical (during the operation, the surgeon frees the ducts for the passage of bile and introduces acids into the gallbladder, dissolving cholesterol stones).

In the case of pigmented or calcified stones, acid-dissolving therapy usually does not help; surgery to remove such formations must be performed before the stones block the common bile duct.

If colic develops against the background of acalculous cholecystitis, accompanied by an enlargement of the organ, and disruption of its functioning, then conservative treatment is prescribed.

To improve biliary function, enzyme replacement therapy is prescribed.

Medicines for hepatic colic

The main symptom of biliary colic is severe pain caused by muscle spasm, so first of all, antispasmodic drugs are prescribed, most often in the form of injections (drotaverine, no-shpa, platifillin, papaverine), after relieving pain, choleretic drugs can be prescribed to improve the functioning of the gallbladder, but they should be taken only after diagnosis and consultation with a doctor.

In the hospital, nonsteroidal anti-inflammatory drugs (metamizole, ketorolac) can be used to reduce pain.

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First aid

In case of hepatic colic, the patient needs complete rest and medical assistance. It is not recommended to warm the stomach, as this can only worsen the course of the disease.

You also cannot consume any foods; you are only allowed to drink still water.

If the pain is severe, you can give a tablet of no-shpa or papaverine.

Algorithm of emergency care for hepatic colic

Before the ambulance arrives, the patient should be provided with maximum rest.

Colic is usually accompanied by frequent vomiting, so antispasmodic drugs in tablet form may not have the desired effect; in case of severe spasms, you can inject atropine, platiphylline, or no-shpa.

The course of further treatment should be prescribed only by a specialist; in some cases, urgent surgical intervention is required, and sometimes conservative treatment helps, which reduces the risk of recurrence of colic.

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Prevention

To reduce the risk of developing biliary colic, diet table No. 5 is prescribed. This diet includes an optimal composition of nutrients.

Patients suffering from hepatic colic should exclude sour vegetables, spinach, sorrel, cocoa, tea, coffee, and fried foods from their diet.

A good preventative measure is physical activity - walking, swimming, gymnastics.

Choleretic drugs or herbs with a choleretic effect also help to prevent an attack - corn silk, agrimony, birch leaves (before taking it, you must consult a doctor).

Forecast

The prognosis of the disease depends on the cause of the colic. If the attack is provoked by gallstone disease, then with stones less than 5 mm in size, the prognosis is almost always favorable. In this condition, surgical intervention is not required, the stones come out on their own.

In other cases, everything depends on the size of the stones, their nature (cholesterol, calcified, etc.).

Biliary colic is a rather dangerous condition that requires immediate medical attention. The attack can last a couple of minutes or several days, but in any case, such a condition requires additional diagnostics and specialist consultation.

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