How is Biliary Colic Diagnosed?

Biliary Colic Explained: Diagnosis, Symptoms & Surgical Care

Biliary colic is a sudden, dull pain in the right upper to middle abdominal region. This usually happens due to obstruction in the bile duct by a gallstone. The bile duct is the passageway for bile from the gallbladder to the small intestine.

Cholecystectomy is the definitive treatment for symptomatic gallstones causing recurrent biliary colic, but initial episodes are often managed conservatively, with elective surgery recommended for recurrent or complicated cases. Although this condition may sound serious, timely diagnosis and effective treatment help avoid such situations. Hence, it is essential to know about the diagnostic modalities available.

Keep reading to understand the major aspects of biliary colic pain, including the diagnostic tests required, the nature of pain, sites of pain, and more.

How Do You Diagnose Biliary Stones?

The diagnosis of biliary stones involves a combination of clinical examination, laboratory examination, and haematological tests. These include:

1.  Medical History & General Examination

The doctor would take a detailed history of the nature, onset, duration, and factors related to the pain. Once the doctor establishes the clinical history, they may palpate and auscultate the area to confirm the site of pain and tenderness.

2.  Haematological Tests

The doctor may prescribe some haematological tests to rule out other complications like inflammation or infection:

• Complete Blood Count (CBC): CBC provides the number and types of blood cells in the body. An elevated white blood cell count indicates the presence of an infection, like cholecystitis.
• Liver Function Tests: In cases of bile duct obstruction, the level of liver enzymes, like ALT, AST, and bilirubin, gets elevated.
• Amylase/Lipase:Normal levels of amylase and lipase help to rule out pancreatitis.

3.  Imaging Tests

• USG: An abdominal ultrasonography is the investigation of choice for biliary colic. It can detect gallstones, obstruction, and inflammation of the gallbladder effectively. Moreover, it is a non-invasive procedure with a high level of accuracy.
• CT scan: The Computed Tomography Scan is used when complications are suspected. A CT scan is less efficient than a USG in detecting gallstones, but it helps to detect abscesses, perforation, or damage to surrounding structures.

This can be helpful in case the USG findings are deemed insignificant.

• EUS: EUS refers to endoscopic ultrasound, which involves an endoscope going through the digestive tract. The endoscope has a transducer, which is a small ultrasound device. EUS helps detect smaller stones that may be missed in an abdominal USG.
• MRCP: MRCP stands for Magnetic Resonance Cholangiopancreatography. MRCP is used to visualise the bile ducts in case of bile duct stones (choledocholithiasis).

What is the Nature of Biliary Colic Pain?

Biliary colic pain is characteristic, as it is:

• Episodic: The pain occurs intermittently, starting and stopping abruptly. Some factors may trigger this pain.
• Persistent: The pain develops gradually to a peak and fades accordingly.
• Severe: The intense pain may feel sharp, cramping, or squeezing and can be severe enough to require emergency care.

Where is the biliary colic pain felt?

The biliary colic pain is usually felt in the upper right abdomen, where the biliary apparatus is located. The pain can also radiate to the back or right shoulder.

What Causes Biliary Colic?

A sudden but temporary increase in pressure within the biliary tract results in temporary biliary colic symptoms. The gallbladder increases pressure by contracting to allow the release of bile into the bile ducts.

Usually, one cannot feel the gallbladder contracting. However, if there is partial blockage or obstruction of bile flow through the bile ducts, the resulting gallbladder contraction will cause pressure to accumulate behind the blockage.

How is biliary colic different from cholecystitis?

Cholecystitis is characterised by gallbladder inflammation. The pain in cholecystitis is similar to that of biliary colic. Indeed, biliary colic may coexist with cholecystitis when the gallbladder has a paroxysmal inflammatory process.

But if the gallbladder inflammation recurs, the pain will persist and even aggravate. This may indicate a severe blockage or infection of the gallbladder, which will require immediate medical attention.

Severe infection or blockage can lead to other symptoms, which include:

• Distended abdomen
• Fever
• Raised heart rate

Biliary colic is a sign of biliary obstruction. Surgical removal of the gallbladder is recommended in patients with recurrent biliary colic or complications, while isolated or infrequent episodes may be managed conservatively. A healthy diet and lifestyle can help prevent gallstones from occurring. However, if the pain does occur, consult a medical professional.

Reader Information: This article is intended for general informational and educational purposes only. Symptoms, diagnostic findings, and treatment options for biliary colic can vary depending on the individual’s overall health, underlying conditions, and disease severity. Always consult a qualified healthcare professional for accurate diagnosis, personalised medical advice, or treatment decisions.

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