Introduction

Biliary colic describes the pain caused by gallstones passing through the biliary tree.

Epidemiology

  • Incidence: 1000.00 cases per 100,000 person-years
  • Peak incidence: 50-60 years
  • Sex ratio: more common in females 3:1
Condition Relative
incidence
Biliary colic1
Acute cholecystitis0.14
Ascending cholangitis0.05
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Risk factors
  • it is traditional to refer to the '4 F's':
    • Fat: obesity is thought to be a risk factor due to enhanced cholesterol synthesis and secretion
    • Female: gallstones are 2-3 times more common in women. Oestrogen increases activity of HMG-CoA reductase
    • Fertile: pregnancy is a risk factor
    • Forty
  • other notable risk factors include:
    • diabetes mellitus
    • rapid weight loss e.g. weight reduction surgery
    • combined oral contraceptive pill

Clinical features

Features
  • colicky abdominal pain, worse postprandially, worse after fatty foods. The pain may radiate to the right shoulder
  • nausea and vomiting are common