- Gall stone colic is typically caused by transient obstruction of the cystic duct by sludge or stones occurring due to contraction of the gall bladder after meals.
- Pain is localized to the epigastrium or right upper quadrant, sometimes radiating to the right scapular tip. Less frequently pain occurs in the left upper quadrant, the precordium or the lower abdomen.Pain may radiate rarely to the right shoulder.
- Pain typically begins postprandially. It is often described as intense and dull. It increases steadily over 10-20 minutes, typically lasts 1 to 5 hours and then gradually wanes.As the gallbladder relaxes, the stone/s fall back from the cystic duct and the pain disappears. Pain lasting more than 6 hours should raise the suspicion of cholecystitis.
- A large fatty meal is more likely to cause pain. Pain may even be nocturnal occurring within a few hours of retiring.
- Biliary colic is a misnomer, because the pain is steady, not intermittent or fluctuating.
- Pain is not relieved by emesis, antacids, defecation, passing flatus, or positional changes. It is sometimes accompanied by diaphoresis, nausea, and vomiting.
- There are no significant clinical findings in uncomplicated gallstone colic except mild tenderness in the upper abdomen. Residual tenderness in the upper abdomen may persist after an attack.
- The only investigation of relevance to diagnose uncomplicated gallstones is ultrasonography of the upper abdomen. Ideally USG should be done in a fasting state as the gall bladder will be contracted after a meal making the stones difficult to visualize.