Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Frequently Asked Questions
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Biliary colic is a type of pain that usually occurs in the upper part of your belly (abdomen), a little to the right or centrally. In some people, it feels like the pain is radiating to their back or their right shoulder.
The pain usually begins suddenly. Once it begins, it’s usually a moderate, steady pain. Most commonly, an episode of biliary colic happens within a couple of hours after a person has eaten a meal, often a large meal with a lot of fat. Unlike some other kinds of abdominal pain, biliary colic doesn’t improve after having a bowel movement.
Usually, the worst of the pain happens about an hour after it starts. Typically, the pain gradually goes away over one to five hours (as the gallstone moves out of the duct).
However, the symptoms of biliary colic don’t always follow this pattern. For example, you might have different patterns in the location and pattern of the pain.
If the pain persists, or if you have a fever, you might not be experiencing biliary colic but complications from your gallstones. For example, some people with gallstones get cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), or cholangitis (infection of the biliary tract).
When to Get Prompt Medical AttentionSeek prompt medical attention if you have the following:Severe painPain with vomitingPain with feverPain that persists for several hoursJaundice (yellowed skin)Darkened urine
When to Get Prompt Medical Attention
Seek prompt medical attention if you have the following:Severe painPain with vomitingPain with feverPain that persists for several hoursJaundice (yellowed skin)Darkened urine
Seek prompt medical attention if you have the following:
Most people continue to have episodes of biliary colic unless they receive treatment. Of people who have a first attack of biliary colic, over 90% will have at least another episode within ten years.
How to Tell Gallbladder and Liver Pain Apart
The Gallbladder, Bile, and the Biliary Tree
To understand what causes biliary colic, it’s helpful to understand a little about the gallbladder and its ducts (called the “biliary tree”).
The gallbladder is a small sac-like organ that sits underneath the liver. The liver produces bile, some of which is stored in the gallbladder.Bileis a thick, green liquid that helps your body digest foods and some kinds of vitamins. Bile exits the gallbladder through a thin duct (the cystic duct) that leads to another duct (the common bile duct). Eventually, this duct empties into part of the small intestine, where the bile can aid in the digestion and absorption of nutrients.
During a meal, various physiological signals make the gallbladder squeeze. This helps get the bile down the biliary tract. A bigger, fattier meal may trigger the gallbladder to squeeze harder.
Normally, this squeezing isn’t a problem. But it can be a problem if your gallbladder starts to squeeze and something is temporarily blocking the biliary ducts. If that happens, it can lead to the symptoms of biliary colic.
Gallstones
Sometimes the bile becomes thick and hardened and forms gallstones (also called “cholelithiasis”). Sometimes gallstones form when the bile contains too much cholesterol or too much bilirubin (a normal breakdown product of hemoglobin).
Researchers are still learning about what causes gallstones to form in some people but not in others. Different types of gallstones have some different risk factors, depending on the composition of the stones. The most common type is cholesterol stones.
Some risk factors for gallstones include the following:
However, some people get gallstones without having any of these risk factors.
Though gallstones are the most common cause of biliary colic, it’s important to realize that most people with gallstones don’t ever experience biliary colic or othercomplications. Most people who have gallstones never experience any symptoms from them.
Diagnosis begins with a full medical history and clinical exam. Your clinician will ask you about your symptoms and your other medical conditions. You’ll also need a physical exam, including a thorough exam of your abdomen. For biliary colic, the abdominal exam is usually normal, except for some possible upper abdominal tenderness. Your clinician should check you for signs of infection (like fever) or yellowed skin (jaundice). This might signal a more serious problem.
Depending on the circumstances, medical history and clinical exam might be enough to diagnose biliary colic, especiallyif you already know that you have gallstonesor if you’ve had an episode of biliary colic before. However, your clinician also needs to distinguish biliary colic from other conditions that can have some overlapping symptoms, like pancreatitis or appendicitis. Some of these conditions need prompt medical interventions, such as surgery.
Other types of complications from gallstones might need to be considered as well. For example, acute cholecystitis (infection of the gallbladder) is a more serious condition than biliary colic, and it might require hospitalization.Cholangitis(infection of the gallbladder ducts) is another potentially serious condition that can occur due to gallstones.
If you’ve had an episode of biliary colic before, and this feels similar, you might not need to see your healthcare provider right away. That may be OK if you aren’t having prolonged or extreme symptoms, fever, jaundice, or other additional issues. If you are at all uncertain if you are having an episode of biliary colic, it’s best to seek medical treatment promptly.
Imaging
You might already know that you have gallstones. For example, they might have been seen on a type of imaging test done for another reason. If so, you might not need additional imaging.
However, if you are not sure if you have gallstones or if your practitioner is worried about a different cause of your symptoms, you might need some imaging tests. An ultrasound of your abdomen is often the first place medical practitioners start, as it is an inexpensive and noninvasive test.
In some situations, you might need additional testing. That might include some of the imaging modalities like the following:
These may help diagnose biliary colic and eliminate other possibilities.
Laboratory Tests
Laboratory tests are also sometimes helpful in diagnosing biliary colic and in ruling out other potential causes. Some common blood tests you might need are:
These tests are also particularly important in making sure another more serious medical issue isn’t the problem.
Management of a Biliary Colic Episode
During an episode of biliary colic, pain control is the cornerstone of treatment. Most commonly, this will mean some type of nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. Other aspects of treatment might include:
Antibiotics do not help in treating biliary colic, since no underlying infection is present. Depending on the situation, you might or might not need hospitalization while you recover from your symptoms.
Longer Term Management
If you’ve had an episode of biliary colic, you are likely to have one again in the future. You have two main options for managing your symptoms. You can manage your condition with diet (and potentially with medication). Or you can opt to have your gallbladder surgically removed.
Surgery
Most commonly, clinicians recommend surgical removal of the gallbladder (cholecystectomy) in people who have had biliary colic. (But if you have gallstoneswithoutbiliary colic, this is not the standard recommendation.)The good news is that because the gallbladder just stores bile and doesn’t have any other important jobs, its removal isn’t usually a serious problem. (Your liver will still continue to make bile that you can use for digestion.)
Surgery is the only definitive way to address the symptoms of biliary colic. Typically, this surgery is donelaparoscopically, using the help of special tools and cameras.This type of surgery uses smaller incisions compared to a laparotomy (also called “open cholecystectomy”), the older surgical option that employs larger cuts through the wall of the abdomen. There are also other types of surgery, such as the minilaparotomy, that use smaller incisions but don’t use laparoscopic tools. Compared to laparotomy, these more minimally invasive surgeries may result in shorter hospital stays and faster recovery, but they may not be an option for everyone.
Laparoscopic removal of the gallbladder is the most commonly performed abdominal surgery in the United States.Most people have good results from it. However, some people do experience some serious side effects that might need follow-up treatment, like a bile leak or injury to the bile duct.And surgery might be riskier if you have certain other medical conditions, or if you are pregnant.Particularly in these cases, you might want to consider non-surgical options first.
Do people tend to do better if they have surgery right after an initial episode of biliary colic or if they take a “wait and see” approach? We don’t have a lot of good data about this. Verylimited evidence suggeststhat going ahead with surgery might decrease the length of hospital stays and the risk of complications.However, there are a lot of factors involved. You will need to work with your healthcare provider to make the best choice for you.
A Word From Verywell
The symptoms of biliary colic include sudden, steady pain felt in the upper area of the abdomen. In some cases, this pain can radiate to the back or right shoulder. Nausea and vomiting are also potential symptoms in some people. The pain from biliary colic is sometimes described as colicky pain.
Yes, you can have biliary colic without a gallbladder. This is because temporary blockage is affecting the bile ducts outside of the gallbladder and not the gallbladder itself.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014;89(10):795-802.Gwon DI, Laasch HU.Radiological approach to benign biliary strictures.Gastrointest Interv. 2015;4(1):9-14. doi:10.1016/j.gii.2015.01.001Pak M, Lindseth G.Risk factors for cholelithiasis.Gastroenterol Nurs. 2016;39(4):297-309. doi:10.1097/SGA.0000000000000235Al Talhi Y, Shirah BH, Altowairqi M, Yousef Y.Laparoscopic cholecystectomy for cholelithiasis in children with sickle cell disease.Clin J Gastroenterol. 2017;10(4):320-326. doi:10.1007/s12328-017-0750-3National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of gallstones.National Library of Medicine: MedlinePlus.Gallstones.Balaji DrG, Ponnapalli DrY, Kb DrT, Kumar DrKS.Comparative study of open cholecystectomy versus laparoscopic cholecystectomy.Int J Surg Sci. 2021;5(4):199-208. doi:10.33545/surgery.2021.v5.i4d.783Gawlik C, Carneval M.A review of the management of bile leaks.Cureus. 2021;13(5):e14937. doi:10.7759/cureus.14937Gurusamy KS, Koti R, Fusai G, Davidson BR.Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic.Cochrane Database Syst Rev. 2013;(6):CD007196. doi:10.1002/14651858.CD007196.pub3Additional ReadingBaiu I, Hawn MT.Gallstones and biliary colic.JAMA. 2018;320(15):1612. doi:10.1001/jama.2018.11868
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014;89(10):795-802.Gwon DI, Laasch HU.Radiological approach to benign biliary strictures.Gastrointest Interv. 2015;4(1):9-14. doi:10.1016/j.gii.2015.01.001Pak M, Lindseth G.Risk factors for cholelithiasis.Gastroenterol Nurs. 2016;39(4):297-309. doi:10.1097/SGA.0000000000000235Al Talhi Y, Shirah BH, Altowairqi M, Yousef Y.Laparoscopic cholecystectomy for cholelithiasis in children with sickle cell disease.Clin J Gastroenterol. 2017;10(4):320-326. doi:10.1007/s12328-017-0750-3National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of gallstones.National Library of Medicine: MedlinePlus.Gallstones.Balaji DrG, Ponnapalli DrY, Kb DrT, Kumar DrKS.Comparative study of open cholecystectomy versus laparoscopic cholecystectomy.Int J Surg Sci. 2021;5(4):199-208. doi:10.33545/surgery.2021.v5.i4d.783Gawlik C, Carneval M.A review of the management of bile leaks.Cureus. 2021;13(5):e14937. doi:10.7759/cureus.14937Gurusamy KS, Koti R, Fusai G, Davidson BR.Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic.Cochrane Database Syst Rev. 2013;(6):CD007196. doi:10.1002/14651858.CD007196.pub3Additional ReadingBaiu I, Hawn MT.Gallstones and biliary colic.JAMA. 2018;320(15):1612. doi:10.1001/jama.2018.11868
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014;89(10):795-802.Gwon DI, Laasch HU.Radiological approach to benign biliary strictures.Gastrointest Interv. 2015;4(1):9-14. doi:10.1016/j.gii.2015.01.001Pak M, Lindseth G.Risk factors for cholelithiasis.Gastroenterol Nurs. 2016;39(4):297-309. doi:10.1097/SGA.0000000000000235Al Talhi Y, Shirah BH, Altowairqi M, Yousef Y.Laparoscopic cholecystectomy for cholelithiasis in children with sickle cell disease.Clin J Gastroenterol. 2017;10(4):320-326. doi:10.1007/s12328-017-0750-3National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of gallstones.National Library of Medicine: MedlinePlus.Gallstones.Balaji DrG, Ponnapalli DrY, Kb DrT, Kumar DrKS.Comparative study of open cholecystectomy versus laparoscopic cholecystectomy.Int J Surg Sci. 2021;5(4):199-208. doi:10.33545/surgery.2021.v5.i4d.783Gawlik C, Carneval M.A review of the management of bile leaks.Cureus. 2021;13(5):e14937. doi:10.7759/cureus.14937Gurusamy KS, Koti R, Fusai G, Davidson BR.Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic.Cochrane Database Syst Rev. 2013;(6):CD007196. doi:10.1002/14651858.CD007196.pub3
Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014;89(10):795-802.
Gwon DI, Laasch HU.Radiological approach to benign biliary strictures.Gastrointest Interv. 2015;4(1):9-14. doi:10.1016/j.gii.2015.01.001
Pak M, Lindseth G.Risk factors for cholelithiasis.Gastroenterol Nurs. 2016;39(4):297-309. doi:10.1097/SGA.0000000000000235
Al Talhi Y, Shirah BH, Altowairqi M, Yousef Y.Laparoscopic cholecystectomy for cholelithiasis in children with sickle cell disease.Clin J Gastroenterol. 2017;10(4):320-326. doi:10.1007/s12328-017-0750-3
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of gallstones.
National Library of Medicine: MedlinePlus.Gallstones.
Balaji DrG, Ponnapalli DrY, Kb DrT, Kumar DrKS.Comparative study of open cholecystectomy versus laparoscopic cholecystectomy.Int J Surg Sci. 2021;5(4):199-208. doi:10.33545/surgery.2021.v5.i4d.783
Gawlik C, Carneval M.A review of the management of bile leaks.Cureus. 2021;13(5):e14937. doi:10.7759/cureus.14937
Gurusamy KS, Koti R, Fusai G, Davidson BR.Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic.Cochrane Database Syst Rev. 2013;(6):CD007196. doi:10.1002/14651858.CD007196.pub3
Baiu I, Hawn MT.Gallstones and biliary colic.JAMA. 2018;320(15):1612. doi:10.1001/jama.2018.11868
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