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 a normal outflow of bile, and colic can provoke spasm of muscles due to irritation of a dense cluster of stones in the organ.

To cause an attack can be an improper diet (fatty, spicy, alcoholic), as well as a strong nervous or physical overexertion.

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

Code for micro-10

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

[1], [2], [3], [4]

Causes of biliary colic

Biliary colic can occur in the absence of gallstones, especially in young women. Up to 15% of laparoscopic cholecystectomy is performed in this pathology. Common causes include the presence of microscopic stones, a violation of gallbladder motility, an overly sensitive biliary tract, dysfunction of the Oddi sphincter, hypersensitivity of the adjacent duodenum and possibly gallstones that have spontaneously resolved. Some patients may develop other functional disorders of the gastrointestinal tract.

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Symptoms of biliary colic

Characteristic manifestations of biliary colic include severe pain on the right side, in some cases it can give back, neck or cover the entire abdomen.

Most often, the attack begins at night, the pain increases with inspiration or if the patient lies on the left side (some investment brings the lying position on the right side with the legs pressed to the abdomen).

During an attack, the person's colic often suffers from frequent vomiting, which usually does not bring relief, the skin becomes pale, with a yellowish tinge, the abdomen becomes swollen, with pressure, there is a sharp pain, muscle spasm.

Body temperature during attacks is usually elevated, the feces acquire a colorless hue, and the urine becomes dark.

The attack can last from 5-7 minutes to 2-3 days, doctors state this condition to those who require immediate medical attention.

Gall-bile colic is considered the main symptom of the formation of stones in the bile. Attacks are manifested by severe pain, which causes spasm of muscles due to the presence of a foreign body (stones).

Diagnosis of biliary colic

Pain-free pain syndrome is suspected in patients with biliary colic, if the results of the examination do not reveal gallstones. Studies include ultrasound and endoscopic ultrasound. To assess the evacuation function of the gallbladder (ejection fraction), cholescintigraphy is performed after the administration of cholecystokinin (avoid use of drugs potentially affecting the outcome, such as calcium channel blockers and anticholinergic drugs). To reveal the dysfunction of the sphincter of Oddi, an ERCP with biliary manometry is performed. To detect duodenal hypersensitivity, an endoscopic barostat test is performed, but this research is carried out only in specialized centers.

[10]

Treatment of biliary colic

Laparoscopic cholecystectomy improves results with microscopic stones and, possibly, with violation of gallbladder motility. The possibility of predicting the effectiveness of treatment of such violations laparoscopic cholecystectomy with the help of other studies is being refined.

Severe pain during an attack of biliary colic is removed with spasmolytic drugs (usually in the form of injections) - papaverine, no-spa, atropine.

With severe pain, Novocaine blockade is used.

Treatment of inflammation of the gallbladder occurs mainly surgically (during surgery, the surgeon releases the ducts for passage of bile and injects acids into the bile, dissolving cholesterol stones).

With pigment or calcified stones, acid-dissolving therapy usually does not help, surgery to remove such formations should be performed before the stones block the common bile duct.

If the colic develops against a background of acalculous cholecystitis, accompanied by an increase in the organ, a disruption of the work, then the treatment is prescribed conservative.

To improve the bile excretory function, substitution enzyme therapy is prescribed.

Drugs for hepatic colic

The main symptom of biliary colic is severe pain caused by spasm of the muscles, therefore, primarily antispasmodics are prescribed, most often in the form of injections (drotaverin, no-shpa, platifilin, papaverine), after removal of pain to improve the bile can be prescribed choleretic preparations , but they should be taken only after diagnosis and consultation with a doctor.

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

[11], [12], [13], [14]

First aid

With hepatic colic, the patient needs complete rest and medical assistance. Warming up the stomach is not recommended, since it can only worsen the course of the disease.

Also you can not eat any products, you can only drink still water.

With severe pain, you can give a pill no-shpy, papaverine.

Algorithm for emergency care for hepatic colic

Before the arrival of an ambulance, you should ensure maximum rest to the patient.

Colic is usually accompanied by frequent vomiting, so spasmolytic drugs in the form of tablets may not have the proper effect, with severe spasms, you can make an injection of atropine, platyphilin, no-shpy.

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

[15], [16], [17]

Prevention

To reduce the risk of developing biliary colic, a dietary table number 5 is prescribed. This diet includes the optimal composition of nutrients.

Patients suffering from hepatic colic should be excluded from the diet of sour vegetables, spinach, sorrel, cocoa, tea, coffee, fried foods.

A good means of prevention is physical activity - walking, swimming, gymnastics.

It is also good to prevent choleretic preparations or herbs with choleretic effect - corn stigmas, crayfish, birch leaves (you should consult a doctor before taking it).

Forecast

The prognosis of the disease depends on the cause of the colic. If the attack is provoked by cholelithiasis, then with stones smaller than 5 mm, the predictions are almost always favorable. In this condition, no surgical intervention is required, the stones go out on their own.

In other cases, all the bruises from the size of the stones, their character (cholesterol, calcined, etc.).

Biliary colic is a rather dangerous condition that requires urgent medical attention. The attack can last a couple of minutes or a few days, but in any case this condition requires additional diagnosis and specialist advice.

[18], [19]