Biliary Colic – Causes, Picture, Symptoms and Treatment

Biliary colic is a constant or occasional pain in the upper abdomen. Commonly this pain occurs under the right rib cage. The pain occurs due to the blockage in the normal bile flow from the gallbladder.

Bile is a complex liquid which contains electrolytes, water and organic molecules such as

• Bile acid
• Phospholipids
• Cholesterol
• Bilirubin

Then, the bile fluid moved from the biliary tract into the small intestine. It is responsible for two essential functions such as

The content of bile acids in bile helps for fat absorption, soluble vitamins absorption in the small intestine and digestions functions.

Bilirubin excretes with other waste products from the body. Every adult individual produces 400-800 ml of bile every day. The bile production occurs in two specific stages such as

Hepatocytes produce bile into canaliculi and the bile travel to bile ducts. The hepatic bile has a large amount of bile acid, other organic molecules, and cholesterol.

When bile comes in the bile duct, it will adjust by bicarbonate and water secretion from ductal epithelial cells.

Where does bile production happen?

The bile fluid is production happens in the liver which stores by the gallbladder (a small sac-like organ under the liver). Whenever you eat, the bile is released by gallbladder through bile duct which is an intermediate tube connected to the liver and small intestine. It helps in digestion of food. There will be chances of bile colic if blockage happens due to gallstone or other conditions.

Causes of Biliary Colic

Biliary colic occurs due to the various causes but the majority of cases shown the problem of gallstones. Here is the list of details causes.

Gallstones

Gallstones are the thick cholesterol deposits which form in the gallbladder. In medical term, it describes as Cholelithiasis.

Gallstones normally develop through calcium deposits, cholesterol particles and some other element present in the bile. These stone have different from shape, size, density, and composition.

Bile contains some amount of calcium, cholesterol and other elements. But the excessive amount of these particles binds together in the gallbladder and form a stone. These stones cause to block to the bile duct and restrict the flow. It may have back pain and indigestion with extreme pain.

Usually, the gallbladder collects the bile when it becomes thick the gallbladder pushes them which also define as biliary colic. It occurs when a gallstone obstructs the bile duct momentarily. This situation generates an intense pain in the abdomen area. This pain may transmit to the shoulders and stays for 1 hour to an extended time.

Gallstone formation occurs due to the excess cholesterol release by the liver which is unable to get dissolve. The extra cholesterol accumulates into solid stone. Other reasons for gallstone formation include the following things.

• The abnormal bile duct valve functions.
• Excessive production of bilirubin in the liver.

Bile Duct Obstruction

It is one of the causes of bile colic. A bile duct obstruction also describes as biliary obstruction. It occurs when the bile duct blocked. If this blockage left untreated, then it leads to severe complications including chronic infection. The bile duct obstruction may occur due to the following problems.

• Gallstones
• Bile duct cancer
• Pancreatic cancer
• Injury from gallbladder surgery
• Choledochal Cysts

The bile duct obstruction may have severe symptoms which can cause the liver to leak the stored bile in the bloodstream. There is also the possibility of bile duct unable to deliver the required quantity of fluids. It may cause to affect the vitamins and fats absorption.

The accumulated bilirubin due to blockage causes jaundice. Due to the bilirubin deficiency in the bile leads to pale stools and dark urine.

Gallbladder Inflammation

A sudden inflammation in gallbladder describes as cholecystitis. If you get repeated attack of inflammation or have continued pain, then it is known as chronic cholecystitis.

Here also gallstone blockage causes repeated inflammation gallbladder which results in cholecystitis.

Continue chronic inflammation can become serious and there are chances of rupturing the gallbladder if not treated correctly. It can have treatments such as medications in the mild problem and require gallbladder removal surgery in serious cases.

Pancreatitis

It is an inflammation of the pancreas gland. Pancreas locates behind stomach which produces enzymes for food digestion. It also helps to manage blood glucose in the body.

Acute pancreatitis happens suddenly and stays for several days. There may possibility of pancreatitis lasting for years.

As the bile duct passes through the pancreas, it also causes biliary colic. When bile needs to travel to the small intestine, it will pass through pancreas, and any infection or inflammation in pancreas affect the bile duct. You will have the following symptoms during pancreatitis.

• Rapid pulse
• Vomiting
• Upper abdominal pain
• Fever
• Nausea
• Radiating abdominal pain to your back
• Increased abdominal pain after a meal
• Tenderness in abdomen
• Weight loss
• Steatorrhea

Biliary cirrhosis

 

Biliary cirrhosis can cause biliary colic. It is an autoimmune disorder which occurred by the posterior scarring and inflammation of the bile duct inside the liver.

The liver is a large organ which is important for removing toxins from blood and absorption of essential nutrition, proteins, carbohydrates, and fats. Therefore any problem happening in the liver can affect the bile duct.

The exact cause of biliary cirrhosis is unknown. But the researcher says it happens due to diet or alcohol.

Women have more chances to develop the primary bile colic than men. This disease shows symptoms at the age of 35 to 60 years.

This disease doesn’t have any cure, but the proper treatment can slow down the disease growth.

Primary bile colic often associates with autoimmune problems such as scleroderma, rheumatoid arthritis, and Sjogren’s syndrome. During biliary cirrhosis, you will experience the following symptoms.

• Rising fatigue
• Skin pigmentation
• Weight loss
• Indigestion
• Joint ache
• Chronic skin itching
• Jaundice
• Abdomen bloating (ascites)
• Upper right abdominal pain around the liver
• Osteoporosis

Biliary fascioliasis

Fascioliasis is a parasitic disease which occurs in sheep and cattle due to Fasciola hepatica worm. Sometimes humans can get an infection by drinking contaminated water or eating cyst-laden water plants.

During the research of US Endoscopic retrograde cholangiopancreatography, three patients revealed the problem of biliary fascioliasis and chronic pain in the upper quadrant.

The research also found the dilatation and thickening of the bile duct in the gallbladder. These symptoms may remain for several months to years.

Sclerosing cholangitis

It describes as primary sclerosing cholangitis which is a disease of bile ducts. Primary sclerosing cholangitis causes scars and inflammation in bile duct which make build duct hard and narrow. It makes difficult for moving digestive liquid. This condition can cause serious damage to the liver.

In maximum cases, the disease of primary sclerosing cholangitis develops slowly. Eventually, it results in infrequent infection, liver failure, and tumors in the liver or bile duct. In such conditions, a liver transplant is the only treatment for overdeveloped sclerosing cholangitis.

For some people, there is the possibility of disease recurrent even after liver transplantation.

In this disease, you will experience the following symptoms such as

• Fever
• Chills
• Night Sweats
• Enlarged spleen
• Enlarged liver
• Weight loss
• Jaundice (Yellow eyes and skin)
• Pain in the upper right abdomen

Symptoms of Biliary Colic

Biliary colic can have different symptoms according to the condition of the patient. Here are major symptoms

Abdomen Pain

During biliary colic, you may experience symptoms of pressure or an ache in the right upper abdomen. The pain can occur below the breastbone and in the center of the upside abdomen. The pain may also occur near the liver and gallbladder.

In some cases, the pain may radiate toward the back and right shoulder. This pain is very discomforting if you sit for a long hour for work purpose.

You will feel intense pain while bending or moving your abdomen.

The pain induces by the digestive system in the demand of bile for the food digestion. Since there is a blockage in the bile duct; it stops bile and causes pain.

Bile reflux

It is a symptom of biliary colic. Bile reflux happens due to reverse of digestive fluid made by the liver into the stomach. It may reflux in the esophagus which is a tube connecting to stomach and mouth.

The bile reflux symptoms occur when the bile duct is blocked with gallstone or swollen by inflammation.

Nausea and vomiting

Vomiting and nausea are the uncommon symptoms of biliary colic. It may occur due to the bile duct infection such as cholangitis. The blockage to bile duct accompanies with infection and fever cause nausea or vomiting.

Loss of Appetite

Loss of appetite also describes as anorexia, which is a hunger absent. An individual with anorexia doesn’t feel to eat.

Even a person with an eating disorder such as bulimia nervosa and anorexia nervosa feel hungry but restrict food intake. Sometimes they have vomiting after having food.

A chronic appetite loss accompanied by severe ailments such as liver failure, heart problem, AIDS, lung problem.

This symptom occurs due to the bile duct obstruction or surgery

Risk factors

The people who frequently develop gallstones have more chances of getting the risk of biliary colic. The group includes:

• People with age above 40
• Women
• Individuals with obesity
• The family history of developing gallstone
• Individuals with a gastrointestinal problem like Crohn’s disorder
• Individuals with insulin resistance or diabetes
• People with cirrhosis – a liver problem
• Individuals with bile duct infection
• Conditions associated with sickle cell anemia

Diagnosis

Keeping an eye on the symptoms is important for the diagnosis of biliary colic. After knowing your particular symptoms, your doctor may conduct a physical examination, particularly in the upper right abdomen. This diagnosis happens around the liver, gallbladder, and pancreas. These are the parts, where the bile duct is connected.

Your doctor may do the ultrasound the painless procedure to get the image of your abdomen. This ultrasound image will help to see the gallstones and blockage part.

Your doctor may advise a blood test if you have constant pain and fever.

Expected Duration

Maximum biliary colic episodes move after 1 – 5 hours. You may experience mild ache for 24 hours after intense biliary colic.

Treatment of biliary colic

The surgical removal of the gallbladder is the proper option to prevent the repeated episodes of biliary colic. If it left untreated, then the repeated pain will occurrence persist.

If you don’t have gallbladder removal, then the gallstones continue to occur. The body continues to function normally without a gallbladder.

Here are the biliary colic treatments such as

Laparoscopic cholecystectomy

It is a surgical procedure to remove the gallstone with the help of a camera which started in the small cut in your abdomen.

Open Cholecystectomy

The surgeon may suggest this procedure in the conditions where the gallbladder is more inflamed or scarred. In this procedure, the gallbladder will get removed from the abdomen by 4 – 6-inch cut.

An individual requires anesthesia during the surgery.

Laparoscopic surgery is given more preference because it helps to recover fast. You don’t need to stay overnight in the hospital, but you need to rest. Later after one week, the patient can continue the normal lifestyle.

Surgery is not a single option for treating biliary colic caused by gallstones. Therapy and medication also help to dissolve the gallstone. It is the best option for treating small stones.

There is another method of shockwave lithotripsy. It requires an ultrasound to find the gallstone then a device transmits shock waves in the body to destroy the gallstone. During this method, there will be no hole or cut made in the skin.

Prevention

As I have discussed above in this article that biliary colic associates to gallstones, it needs to prevent the composition of gallstones. Some risk factors relate to frequent gallstones such as pregnancy, heredity, and aging can cause gallstone formation.

A woman who is experiencing menopause and taking estrogen hormones replacement therapy are more inclined to produce gallstones.

Biliary colic and diet

To avoid biliary colic and gallstone, you need to limit the refined carbohydrates and low fiber calories.

Refined carbohydrates such as white rice, bread. These foods have a high risk of developing gallstones.

Saturated fats content foods such as cakes, fatty meats, butter, sausage cause to increase the cholesterol.

Eat a healthy diet which contains fresh green vegetables, fresh fruits, lean proteins, and whole grain carbohydrates. A healthy lifestyle can prevent the gallstone.

In most cases, some people don’t get biliary colic while having a gallstone. It is possible that some time gallbladder related conditions grow silently and don’t show any symptoms. Your digestive system works fine without a gallbladder, so it requires removal in chronic conditions. After removing the gallbladder, the bile flows directly in the small intestine and cause no pain.

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