Biliary Colic 

What is Biliary Colic?

Biliary colic, commonly known as gallstone pain, is a common condition in Singapore characterised by severe abdominal pain caused by the temporary blockage of the gallbladder outflow by gallstones. The gallbladder serves as a storage facility for bile, concentrating it until it is needed during digestion. 

When gallstones, solid particles formed from bile cholesterol and bilirubin block the opening gallbladder, they increase the pressure in the gallbladder, causing spasms and significant pain known as biliary colic. Though "colic" suggests intermittent pain, biliary colic results in continuous discomfort until the blockage is resolved.

What causes Biliary Colic?

Biliary colic occurs when the gallbladder contracts, resulting in a gallstone impacting the gallbladder's opening. Gallstones are hard masses made of cholesterol and bilirubin. They can be large or small, and their numbers can vary from a few to many. 

What are the symptoms of Biliary Colic?

The symptoms of biliary colic can be quite severe and typically manifest suddenly, often after a meal high in fat, which prompts the gallbladder to release bile. Common symptoms of biliary colic include:

• Severe pain: the hallmark symptom of biliary colic is pain in the upper right abdomen or the middle of the abdomen, lasting from several minutes to a few hours.
• Radiating pain: biliary colic pain may spread to the back or right shoulder blade, adding to the discomfort.
• Digestive issues: nausea and vomiting may accompany the pain as the body reacts to the blockage.

The pain associated with biliary colic is described as gripping or gnawing and may vary in intensity. It often occurs at night or early in the morning and can be so severe that it requires immediate medical attention. 

The pain arises from the gallbladder contracting vigorously in an attempt to push the gallstone. This contraction causes a sharp, intense pain that can make it difficult to find a comfortable position. The nature of the pain, coupled with nausea and vomiting, can be debilitating, significantly impacting the quality of life until the episode is resolved or is treated.

Who is at risk of Biliary Colic in Singapore?

Biliary colic does not discriminate, but certain groups of people in Singapore are more susceptible to developing this condition due to a combination of genetic, lifestyle, and dietary factors. Risk factors of biliary colic include:

• Gender: women are more likely than men to develop gallstones, bile ducts, and, hence, biliary colic. This increased risk is partly due to oestrogen, which can increase cholesterol concentration in bile and slow gallbladder movement.
• Age: the risk of developing gallstones and biliary colic increases with age. 
• Obesity: carrying excess body weight significantly increases the risk of gallstones. Fat tissue alters the balance of cholesterol and bile salts in the gallbladder, making gallstone formation more likely.    
• Diet: a diet high in fat and cholesterol and low in fibre can promote the formation of cholesterol gallstones. Conversely, a rapid weight loss diet or fasting can also increase the risk as it can temporarily increase cholesterol levels in the bile.
• Family history: genetics play a role in forming gallstones and biliary colic. If you have a family history of gallstones, you are at a higher risk of developing them yourself.
• Lifestyle: a sedentary lifestyle can contribute to the risk of gallstones and, subsequently, biliary colic.
• Medical conditions: Conditions like diabetes mellitus and certain blood disorders increase the risk due to associated metabolic imbalances.

How is Biliary Colic diagnosed?

To diagnose biliary colic, the following diagnostic tests are conducted:

• Ultrasound: the primary tool for diagnosing gallstones, abdominal ultrasound is non-invasive and highly effective in detecting gallstones in the gallbladder.
• Computed tomography scan (CT scan): though less commonly used for gallstones, CT scans can provide detailed images that help diagnose other potential causes of abdominal pain.
• Magnetic resonance cholangiopancreatography (MRCP): MRCP is a special type of magnetic resonance imaging (MRI) focusing on the liver, bile ducts, and pancreas. It is particularly useful for identifying gallstones in the bile ducts.
• Blood tests: while not able to directly diagnose gallstones, blood tests can identify signs of infection, inflammation, liver function issues, or complications arising from gallstones.

What are the treatment options for Biliary Colic in Singapore?

The treatment of biliary colic in Singapore depends on the severity of the symptoms and whether the gallstones are causing complications:

• Medication: Pain medication to relieve pain. Medication for patients who are not fit for surgery to try to dissolve a single, small stone. This is not effective as it takes a long time to see the effect, and the stone may recur. 
• Surgical treatment: the most definitive treatment for symptomatic gallstones is the surgical removal of the gallbladder, known as a cholecystectomy. In Singapore, laparoscopic cholecystectomy is preferred due to its minimally invasive nature, resulting in less pain and quicker recovery times than traditional open surgery.

Each treatment plan is tailored to the individual's specific situation, focusing on relieving symptoms, preventing complications and improving quality of life.

Frequently asked questions

How do you manage biliary colic?

Individuals with biliary colic are usually prescribed painkillers to help alleviate symptoms. Additionally, individuals may be advised on lifestyle modifications such as a high-fibre, low-fat diet, weight loss, and increased exercise.

What is the difference between biliary colic and gallstones?

Gallstones do not cause symptoms until they cause an obstruction or blockage of the gallbladder outflow. When this happens, it can cause acute and severe abdominal pain, known as biliary colic.

What triggers biliary colic?

Biliary colic is typically triggered after a high-fat meal, which signals the gallbladder to contract and release stored bile. However, bile flow is restricted because the outflow is blocked, resulting in pain from gallstones or biliary colic.