Biliary Colic: Causes, Symptoms, Treatment and Cost

Biliary colic is defined as abdominal pain caused by an obstruction in the biliary tree's cystic duct or common bile duct. Gallstones obstruct the bile ducts resulting in a specific form of stomach discomfort known as biliary colic. It usually happens after a large, fatty meal, which causes the gallbladder to contract.

Biliary Colic is divided into the following types :

• Acute Biliary Colic: This type of biliary colic occurs when there is a sudden decrease in bile passage and increased tension in the affected muscles.
• Chronic Biliary Colic: This type of biliary colic occurs when there is a recurrent blockage of the bile ducts, resulting in recurring episodes of abdominal pain and nausea. The pain may come and go over several weeks or months and can be more difficult to diagnose than acute biliary colic.
• Gallstone Pancreatitis: Gallstones that become stuck in the pancreatic duct and inflame the pancreas are what cause this particular kind of biliary colic, which is characterized by excruciating stomach pain, nausea, vomiting, and fever.
• Cholangitis: This type of biliary colic occurs when bacteria or other substances enter into the bile ducts from elsewhere in the body and cause an infection or inflammation known as cholangitis.

Biliary Colic could be caused by various factors. The major causes of Biliary Colic include:

• Biliary colic is caused by Gallstones blocking the cystic duct and bile duct: Gallstones are hard deposits of cholesterol and bile salts that can form, blocking the cystic duct and bile duct, leading to the pain associated with biliary colic.
• Reduced motility of the gallbladder: Reduced motility (movement) of the gallbladder can also lead to blockage of the cystic duct and/or bile ducts.
• Infection in the biliary tract: An infection in the biliary tract can cause blockage of the cystic duct and/or bile ducts, leading to inflammation and swelling in these areas, resulting in pain from biliary colic.

A person suffering from Biliary Colic can show the following symptoms which include:

• Severe abdominal pain: caused by a blockage or spasm in a bile duct.
• Nausea, vomiting, loss of appetite: symptoms that can occur with biliary colic due to the underlying pain.
• Fever and chills: Other typical signs of infection resulting in jaundice from a clogged bile duct.
• Jaundice: yellowing of the skin or eyes due to a buildup of bilirubin in the bloodstream caused by blocked bile ducts.
• Abdominal bloating or distention: another common symptom as a result of blocked bile ducts leading to fluid buildup in the abdomen.

There are various ways by which prevention from Biliary Colic can easily occur, Some of them include:

• Healthy diet: Consuming a diet that is low in fat, high in fiber, and rich in fruits and vegetables can help prevent biliary colic.
• Exercise: Regular exercise may assist in preventing gallstone development, which may result in biliary colic.
• Weight control: Keeping your weight within a reasonable range will help you avoid developing gallstones and biliary colic.
• Be hydrated: Consuming enough liquids, particularly water, may lower the risk of biliary colic and help avoid the production of gallstones.
• Limit alcohol consumption: Consuming too much alcohol can increase the risk of developing biliary colic.

Biliary Colic can be diagnosed by physicians with the help of the following test :

• Ultrasound: An imaging test that uses sound waves to create pictures of the bile ducts and gallbladder.
• Cholangiography: An X-ray test that can show blockage in the bile duct, or other problems with the gallbladder and bile ducts.
• CT (Computed Tomography) scan: A scan that uses X-ray technology and a computer to create detailed images of structures within the body
• MRI (Magnetic Resonance Imaging): an imaging test using magnetic fields and radio waves to produce detailed images of the structure and organs of the body.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): an imaging test that involves inserting an endoscope through the mouth and into the small intestine while taking X-rays, to assess any blockages or other problems in the bile ducts or gallbladder.
• Liver function tests: Blood tests are performed to check for levels of liver enzymes to evaluate the overall functionality of the liver and for any signs of diseases in this organ related to Biliary Colic

If Biliary Colic is not treated on time then it could lead to various complications which include:

• Acute Cholecystitis: This is a condition where the gallbladder becomes inflamed due to the presence of gallstones. Symptoms include severe pain, fever, and nausea.
• Jaundice: Biliary colic can cause blockages in the bile ducts, leading to the buildup of bilirubin in the blood. The skin and eyes may become yellow as a consequence of this.
• Pancreatitis: Gallstones may sometimes obstruct the pancreatic duct, leading to pancreatitis. This may cause vomiting, nausea, and excruciating stomach discomfort.
• Cholangitis: When bile flow is stopped, the bile ducts may get seriously infected. Symptoms include fever, chills, and abdominal pain.
• Gallbladder Cancer: Although rare, biliary colic can increase the risk of developing gallbladder cancer over time.
• Chronic Cholecystitis: This is a long-term inflammation of the gallbladder that can lead to scarring and reduced function. Symptoms include abdominal pain, nausea, and bloating.
• Gallstone Ileus: In rare cases, gallstones can become lodged in the small intestine, causing a blockage. Dehydration, vomiting, and severe stomach discomfort may result from this.
• Bile Duct Stricture: Prolonged blockage of the bile ducts can cause scarring and narrowing, leading to reduced bile flow and potential complications. Symptoms include jaundice, abdominal pain, and itching.
• Gallbladder Empyema: This is a rare but serious complication of acute cholecystitis, where the gallbladder becomes infected and filled with pus. Symptoms include fever, severe abdominal pain, and nausea.
• Bile Peritonitis: This is a potentially life-threatening condition where bile leaks into the abdominal cavity, causing inflammation and infection. Symptoms include severe abdominal pain, fever, and rapid heartbeat.

If you are suffering from Biliary Colic or any symptoms regarding Biliary Colic then these basic remedies could help you. These remedies include:

• Drink a glass of warm water mixed with a teaspoon of turmeric powder every morning on an empty stomach.
• Boil a few pieces of ginger in water and drink the decoction to reduce inflammation and pain in the biliary tract.
• Mix equal parts of cumin powder, fennel powder, and coriander powder and consume a teaspoon of this mixture with warm water after meals to improve digestion and prevent biliary colic.
• Massage the abdominal area with warm sesame oil in a clockwise direction to stimulate the flow of the bile and relieve pain.
• Eat a diet low in fat, high in fiber, and rich in fresh fruits and vegetables to prevent the formation of gallstones and alleviate symptoms of biliary colic.
• Drink freshly squeezed lemon juice mixed with warm water and honey to help dissolve gallstones and improve liver function.
• To encourage bowel motions and purify the body, take a spoonful of Triphala powder with warm water before night.
• Practice yoga asanas like Bhujangasana (Cobra pose), Dhanurasana (Bow pose), and Ardha Matsyendrasana (Half spinal twist pose) to improve digestion and reduce stress levels.

Diet plays the most important part in the treatment of Biliary Colic. Here is the meal which should be prescribed to the patient with Biliary Colic:

• Low-fat foods: Biliary colic is often caused by the presence of gallstones, which can obstruct the bile duct and cause pain. Eating low-fat foods can help reduce the production of bile and ease symptoms. Examples include fruits, vegetables, lean proteins, and whole grains.
• High-fiber foods: A diet rich in fiber may lower the incidence of biliary colic and aid in gallstone prevention. Whole grains, fruits, vegetables, legumes, and nuts are all excellent sources of fiber.
• Water: The gallbladder may be flushed out and gallstones can be avoided by drinking lots of water. It may also lessen pain and inflammation.
• Herbal teas: Certain herbal teas, such as chamomile, peppermint, and ginger, can help reduce inflammation and soothe the digestive system. They may also help relieve pain associated with biliary colic.

It's vital to stay away from certain meals since they may make these symptoms worse. Here are some foods to avoid in biliary colic:

• High-fat foods: Fatty foods can trigger the gallbladder to release more bile, which can exacerbate pain and discomfort in biliary colic. Steer clear of high-fat meals including fried items, red meat, cheese, cream, butter, and whole dairy products.
• Spicy foods: Spicy meals may aggravate digestive discomfort and inflammation, which can exacerbate biliary colic pain and discomfort.
• Avoid spicy foods such as hot peppers, chili, and curry.
• Alcohol: Alcohol can worsen inflammation and irritate the gallbladder, which can aggravate pain and discomfort in biliary colic. Avoid alcohol or only consume it in moderation.
• Caffeine: Caffeine can stimulate the digestive system and cause the gallbladder to contract, which can worsen pain and discomfort.

The best treatments for Biliary Colic include:

• Laparoscopic cholecystectomy: The gallbladder, a tiny organ situated below the liver, is removed during this minimally invasive surgical operation. Biliary colic, which occurs when a gallstone becomes lodged in the bile duct, is treated with it.
• Endoscopic retrograde cholangiopancreatography (ERCP): To achieve this, a tube with a camera attached must be inserted down the patient's throat, down the small intestine, and finally into the bile duct. This allows a gastroenterologist to see any gallstones within and then make them available for removal.
• Open surgery: An operation on the abdomen that requires anesthesia and an incision made in the abdominal wall may also be performed to remove one or more gallstones from the bile ducts.
• Extracorporeal shockwave lithotripsy (ESWL): This procedure uses high-frequency sound waves to break large stones into smaller pieces that can pass through more easily and be removed from the body through natural excretion routes such as urine or stool.
• Percutaneous transhepatic cholangiography (PTC): This surgical technique involves injecting dye directly into the patient's biliary system and using imaging techniques, such as ultrasound or CT scan, to see where the blockage has occurred and access it with specialized instruments if needed.

Biliary colic is usually treated by a gastroenterologist, a doctor that specializes in digestive health. A gastroenterologist will be able to identify the pain's primary source and provide therapy suggestions to help it go away.

The following drugs and medicines are important for the treatment and management of biliary colic:

• Antispasmodics: These medications work by relaxing the muscles of the biliary tract, reducing pain caused by biliary colic. Examples of antispasmodics include hyoscine, atropine, and papaverine.
• Choleretics: These drugs stimulate bile production and flow from the gallbladder, helping to relieve biliary colic symptoms. Commonly used choleretics include ursodiol and chenodeoxycholic acid.
• Analgesics: Painkillers are often prescribed to alleviate pain associated with biliary colic. Commonly used analgesics include ibuprofen and acetaminophen.
• Opioids: These drugs can also be used to help reduce moderate to severe pain caused by biliary colic. Examples of opioids used for this purpose include morphine and codeine.

Depending on the severity of the ailment and the therapy received, biliary colic recovery times might vary.

It may take a few hours or days for symptoms to go away in some circumstances, while it might take several weeks in other cases.

The surgery for biliary colic, also known as cholecystectomy, is a permanent solution to the recurring pain and discomfort caused by gallstones.

• The removal of the gallbladder, where the stones are formed, eliminates the source of the problem and prevents future episodes of biliary colic.
• Patients who undergo cholecystectomy typically experience significant relief from their symptoms, including abdominal pain, nausea, and vomiting. They may resume their regular schedule and nutrition without worrying about starting another episode.
• Overall, the results of cholecystectomy for biliary colic are highly successful, with most patients reporting improved quality of life and long-term relief from their symptoms.

After a patient has undergone treatment for biliary colic, there are several post-treatment steps that they should follow to ensure a smooth recovery:

• Follow the medication regimen: The patient should follow their doctor's instructions while taking any recommended drugs. This may include pain relievers, antibiotics, or other medications.
• Rest and recuperate: The patient should get plenty of rest and avoid strenuous activities for a few days after treatment.
• Modify their diet: The patient should avoid fatty, greasy, or spicy foods for a few weeks after treatment, as these can aggravate the digestive system.
• Stay hydrated: To assist flush out any lingering toxins or waste products from their system, the patient should consume lots of water and other liquids.
• Attend follow-up appointments: All further doctor's visits should be attended by the patient to track their recovery and development.
• Patients may decrease the chance of problems or biliary colic recurrence by following these post-treatment instructions to assist guarantee a good recovery.

Depending on the severity of the ailment and the facility of choice, the cost of biliary colic treatment in India might vary.

On average, the cost can range from INR 20,000 to INR 50,000. This includes expenses for hospitalization, diagnostic tests, medications, and consultation fees.

Biliary colic is managed with medications that may have potential side effects. The following are some of the frequent adverse reactions of biliary colic treatment:

• Nausea and vomiting: Some medications used to treat biliary colic may cause nausea and vomiting. These symptoms are generally mild but can be bothersome for some individuals.
• Diarrhea: Certain drugs like antacids or muscle relaxants used in the treatment of biliary colic can cause diarrhea as a side effect.
• Dizziness and lightheadedness: Some drugs used in the treatment of biliary colic may cause dizziness and lightheadedness. This can lead to falls or accidents, especially in elderly patients.
• Allergic reactions: Occasionally, a few people might have an adverse response to the drugs used to treat biliary colic. An allergic response could include a rash, itching, breathing problems, or face swelling. If any of these symptoms appear, it is crucial to get emergency medical help.
• Changes in blood pressure: In certain circumstances, blood pressure changes brought on by specific drugs used to treat biliary colic might result in high or low blood pressure.
• Liver toxicity: Long-term use of some medications for biliary colic may lead to liver toxicity, which can cause liver damage in rare cases.
• Infertility: Some medications like bile acid sequestrants may block the absorption of essential nutrients and cause fertility issues in women.
• Gastrointestinal bleeding: NSAIDs or Aspirin used for pain management in biliary colic may increase the risk of gastrointestinal bleeding in some cases.

If you are experiencing any complications that are related to biliary colic, then you should see a doctor as soon as possible. These complications can include things like acute cholecystitis, jaundice, pancreatitis, and other similar conditions, the treatment for which can last anywhere from a few months to several years depending on how severe the underlying condition is.