biliary colic (biliary spasm)
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Etiology
- sudden obstruction of the cystic duct or common bile duct
Clinical manifestations
- epigastric or right upper quadrant (RUQ) pain
- may radiate to right scapular tip (Collins sign)
- rapid onset
- steady aching pain, not colicky
- pain lasts one to several hours (30 minutes to 6 hours)[2]
- often recurrent
- episodes sporadic & unpredictable[3]
- anorexia
- nausea/vomiting
Radiology
* proceed directly to cholecystectomy if recurrent biliary colic & prior RUQ ultrasound showing cholelithiasis[4]
Differential diagnosis
- fever, leukocytosis, elevated liver function tests suggest acute cholecystitis or common bile duct obstruction[2]
Management
- non-steroidal anti-inflammatory drugs (NSAIDs)
- relief of pain
- decrease risk of acute cholecystitis[2]
- elective cholecystectomy if RUQ abdominal ultrasound shows gallstones
More general terms
References
- ↑ Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 72
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 3.0 3.1 Shalkow J Fast Five Quiz: Test Your Knowledge of Gallstones Medscape. June 12, 2018 https://reference.medscape.com/viewarticle/897845
- ↑ 4.0 4.1 NEJM Knowledge+ Gastroenterology