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Gallstones and biliary colic

  • Gallstones: Solid particles that form in the gallbladder from cholesterol, bilirubin, and other components of bile.
  • Biliary Colic: Intermittent pain caused by the contraction of the gallbladder against a blocked cystic duct.
  • More common in females, especially those of child-bearing age.
  • Increased prevalence with age, obesity, pregnancy, rapid weight loss, and certain medications.
  • Associated with the “Four F’s”: Fat, Forty, Female, Fertile.
Types of Gallstones
  • Cholesterol stones: Most common type, yellow-green, predominantly from cholesterol.
  • Pigment stones: Black or brown, made of bilirubin.
Clinical Features
  • Many gallstones are asymptomatic.
  • Biliary Colic:
    • Sudden onset of severe pain in the right upper quadrant or epigastrium.
    • Lasts 1-5 hours, can radiate to the right shoulder.
    • Nausea and vomiting may accompany the pain.
    • Triggered by fatty meals.
  • Ultrasound: First-line imaging; reveals gallstones and gallbladder wall thickening.
  • MRCP (Magnetic Resonance Cholangiopancreatography): If stones in the common bile duct are suspected.
  • Liver function tests: Can show elevated bilirubin and alkaline phosphatase if there’s obstruction.
  • Asymptomatic gallstones: Usually no treatment needed.
  • Biliary Colic: Pain relief with NSAIDs or opioids.
  • Cholecystectomy (surgical removal of the gallbladder) for recurrent biliary colic or complications.
  • Ursodeoxycholic acid: Medication to dissolve cholesterol gallstones, but used less commonly due to slow action and recurrence of stones.
  • Cholecystitis: Inflammation of the gallbladder.
  • Choledocholithiasis: Stones in the common bile duct.
  • Cholangitis: Infection of the bile duct.
  • Gallstone pancreatitis: Stone blocking the pancreatic duct.

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