Biliary colic: Information & biliary colic specialists

Leading Medicine Guide Editors
Leading Medicine Guide Editors
In biliary colic, the outflow of the bile ducts is disturbed by gallstones. The bile ducts try to break down the stone through contractions. Biliary colic is very painful and can last up to five hours. Treatment is usually done by dissolving or breaking up the stones. Surgery may be necessary for very large gallstones.

Here you will find further information as well as selected specialists and centres for biliary colic.

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Brief overview:

  • What is biliary colic? Blockage of the bile ducts due to gallstones which is experienced as very painful. The pain is caused by muscle contractions through which the body tries to move the stones on.
  • Causes: If gallstones are present, they can enter the bile ducts owing to increased production of bile after eating heavy, fatty food. 
  • Symptoms: Severe cramp-like, wave-like pain in the right and middle upper abdomen, possibly accompanied by nausea, belching and flatulence. Biliary colic can last up to five hours. Further complications may occur.
  • Diagnosis: Gallstones can be detected in the ultrasound image. An examination of the bile ducts by means of ERCP leads to very precise results; gallstones can also be removed in the process.
  • Treatment: Depending on the size of the gallstones and the exact cause, treatment may vary: Dissolving drugs as well as painkillers, shock wave therapy and in individual cases surgical removal of the gallbladder are among the options.

Article overview

What is biliary colic?

Biliary colic is caused by trapped Gallstones in the bile ducts. The muscles located in the walls of the bile ducts try to move the stones further by means of contractions. The patient feels cramp-like pain in the right upper abdomen. It can radiate to the right shoulder and back.

The discomfort can last up to five hours.

Causes of biliary colic

The gallbladder lies in the gallbladder fossa behind the liver in the right upper abdomen. The liver produces bile, which the intestine needs for digestion. The main function of the gallbladder is to collect this bile and release it through the bile duct into the duodenum when food is consumed.

There, the bile emulsifies the food pulp. The gallbladder is equipped with several sphincters that regulate the outflow of bile through contractions.

Some people develop gallstones, which disrupt the flow of bile. Heavy fatty foods cause the gallbladder to produce more fluid. It must be released into the intestine to process the food pulp. This bile secretion flushes the gallstone into the bile duct, where it remains in front of the bile outlet.

Through contractions of the bile walls, the biliary system tries to transport the bile and the gallstone into the intestine. These contractions cause a cramping pain in the patient, which is known as biliary colic.

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

Symptoms of biliary colic

Severe, cramping, wave-like pain is the main symptom of biliary colic. It is mainly localised in the right and middle upper abdomen, but also on the back and shoulder. The pain may be accompanied by

Biliary colic lasts between 15 minutes and 5 hours. Most often, the gallstone is excreted as a result of biliary colic.

Those affected often feel a strong urge to move during biliary colic. Exercise facilitates the passage of gallstones.

As a rule, the bile ducts are still irritated for a few days after a biliary colic.

Biliary colic can cause serious complications, including

How is biliary colic diagnosed?

By means of ultrasound examination (sonography), gallstones, the triggers of biliary colic, can be easily visualised. The examiner feels the

  • the gallbladder,
  • Bile ducts and
  • Liver and
  • mostly also the pancreas

by means of a transducer.

An endoscopic retrograde cholangiopancreaticography (ERCP) is mainly performed if gallstones are suspected in the bile ducts. Besides the presentation

  • of the bile ducts,
  • gall bladder and
  • of the pancreatic duct

the doctor can also use it to remove stones or widen the opening of the bile duct.

How is biliary colic treated?

Biliary colic can be treated in different ways, depending on what has triggered it and the size of the gallstones.

As a general rule, do not eat for 24 hours after having biliary colic. Afterwards, make sure you eat a healthy diet rich in fibre.

For mild biliary colic, dissolving drugs containing artificial bile acid are prescribed. The gallstones must then not be larger than five millimetres and must be calcium-free. In addition, the patient receives medication to relieve cramps and pain. As soon as the stones recede, the biliary colic subsides.

Also stone disintegration by means of shock waves (ultrasound wave treatment) is possible. The fragments of the gallstones are then dissolved with medication.

In the case of biliary colic triggered by larger gallstones, which also reoccurs, surgery is necessary. By removing the gallbladder (cholecystectomy), the complaints also disappear.

Gall bladder removal is a minimally invasive procedure. Only four small incisions are necessary to insert the instruments. With the help of gas, the surgical area is then inflated so that the individual structures can be separated from each other.

After the operation, small sutured incisions remain, which are hardly visible after some time.

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