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biliary colic (biliary spasm)

Etiology: - sudden obstruction of the cystic duct or common bile duct Clinical manifestations: 1) epigastric or right upper quadrant (RUQ) pain - may radiate to right scapular tip (Collins sign) 2) rapid onset 3) steady aching pain, not colicky 4) pain lasts one to several hours (30 minutes to 6 hours) [2] 5) often recurrent 6) episodes sporadic & unpredictable [3] 6) anorexia 7) nausea/vomiting Radiology: - RUQ abdominal ultrasound* * 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) a) relief of pain b) decrease risk of acute cholecystitis [2] - elective cholecystectomy if RUQ abdominal ultrasound shows gallstones

General

colic biliary disease

References

  1. Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 72
  2. 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. Shalkow J Fast Five Quiz: Test Your Knowledge of Gallstones Medscape. June 12, 2018 https://reference.medscape.com/viewarticle/897845
  4. NEJM Knowledge+ Gastroenterology