Biliary Colic – Upper Abdomen, Pain in the Upper Abdomen, Cramping and Spasmodic Pain in the Upper Abdomen Caused by Gallstones: Symptoms and Treatment

Biliary colic is caused by gallstones becoming lodged in the bile ducts. The muscles in the walls of the bile ducts contract in an attempt to move the stones along. The patient experiences cramp-like pain in the upper right abdomen. The pain may radiate to the right shoulder and back.

The symptoms can last up to five hours.

Biliary colic is triggered by gallstones becoming lodged in the bile ducts. The muscles in the walls of the bile ducts contract in an attempt to move the stones along. The patient experiences cramp-like pain in the right upper abdomen. This pain may radiate to the right shoulder and back. The symptoms can last up to five hours.

The gallbladder is located in the gallbladder fossa behind the liver in the right upper abdomen. The liver produces bile, which the intestines need for digestion. The main function of the gallbladder is to store this bile and release it into the duodenum via the bile duct when food is ingested.

There, the bile emulsifies the chyme. The gallbladder is equipped with several sphincters that regulate the flow of bile through contraction.

Some people develop gallstones, which interfere with the flow of bile. Heavy, fatty meals cause the gallbladder to produce more bile. This bile must be released into the intestine to help digest the food. This bile flushes the gallstone into the bile duct, where it becomes lodged just before the bile outlet.

The biliary system attempts to release the bile and the gallstone into the intestine by contracting the walls of the bile ducts. These contractions cause the patient to experience a cramp-like pain known as biliary colic.

Gallstones form in the gallbladder and bile ducts and can cause biliary colic © Henrie | AdobeStock

Severe, cramp-like, wave-like pain is the main symptom of biliary colic. It is primarily localized in the right and central upper abdomen, but can also be felt in the back and shoulder. The pain may be accompanied by

• nausea,
• belching,
• bloating, and
• a feeling of fullness.

A biliary colic lasts between 15 minutes and 5 hours. In most cases, the gallstone is passed as a result of a biliary colic. Often, those affected feel a strong urge to move during a biliary colic. Movement facilitates the passage of gallstones. As a rule, the bile ducts remain irritated for a few days after a biliary colic.

A biliary colic can lead to serious complications, including

• jaundice,
• cholecystitis, and
• pancreatitis.

An ultrasound examination (sonography) can clearly visualize gallstones, which are the cause of biliary colic. During the exam, the examiner

• the gallbladder,
• bile ducts, and
• liver and
• usually the pancreas as well

using a transducer.

Endoscopic retrograde cholangiopancreatography (ERCP) is primarily performed when gallstones in the bile ducts are suspected. In addition to visualizing

• the bile ducts,
• gallbladder, and
• the pancreatic duct

, the doctor can also use this procedure to remove stones or dilate the opening of the bile duct.

Biliary colic can be treated in various ways, depending on its cause and the size of the gallstones.

As a general rule, do not eat anything for 24 hours after an attack of biliary colic. Afterward, be sure to follow a healthy, high-fiber diet.

For mild biliary colic, dissolving medications containing synthetic bile acids are prescribed. The gallstones must not be larger than five millimeters and must be free of calcium. In addition, the patient is given medication to relieve cramps and pain. As soon as the stones dissolve, the biliary colic subsides.

Stone fragmentation using shock waves (ultrasound wave treatment) is also an option. The fragments of the gallstones are then dissolved with medication.

Surgery is necessary for biliary colic caused by larger gallstones that recur frequently. Removing the gallbladder (cholecystectomy) eliminates the symptoms.

Gallbladder removal is a minimally invasive procedure. Only four small incisions are needed to insert the instruments. The surgical site is then inflated with gas so that the individual structures can be distinguished from one another.

After the surgery, small sutured incisions remain, which become barely visible after some time.

What is biliary colic, and what causes it?

Biliary colic is usually caused by gallstones that block the bile duct. The gallbladder spasms because bile cannot flow into the small intestine. This colic causes sudden, cramp-like pain in the upper abdomen.

How long does biliary colic last?

A biliary colic can last anywhere from 15 minutes to 5 hours. In rare cases, the pain may persist for longer than a few hours. If you experience acute biliary colic with persistent symptoms, you should seek medical attention.

What are the typical symptoms?

Typical symptoms of biliary colic include severe, colicky pain in the right upper abdomen, below the liver. Nausea, vomiting, and occasionally jaundice may occur if the bile duct is completely blocked. The intense, belt-like pain is also described as labor-like pain.

How is biliary colic diagnosed?

Diagnosis begins with a medical history and physical examination. An ultrasound often reveals gallstones in the gallbladder or abnormalities of the gallbladder. If necessary, an ERCP with an endoscope can be performed to remove gallstones from the bile ducts.

How is it treated, and can biliary colic be prevented?

The goal of treatment is to relieve the severe pain and dislodge impacted gallstones. In many cases, the gallbladder is removed, usually through a cholecystectomy, which is sometimes performed under general anesthesia. To prevent biliary colic, high-fat meals should be limited, and risk factors such as obesity should be addressed.