Introduction

Acute biliary colic can indicate a number of gallbladder pathologies that are related to gallstones but are managed in different ways. Biliary colic is a common ED presentation. The major challenge is to ensure that the patient doesn’t have serious secondary complications secondary to gallstones. i.e. Cholecystitis, Cholangitis, Pancreatitis, Septicaemia, Gallbladder gangrene and perforation.

There are a number of similar sounding terms related to gallbladder pathologies that are very similar and commonly trip people up which are listed below.

Cholelithiasis - gallstones in the gallbladder. Might or might not be asymptomatic

Biliary Colic - Acute colicky pain, the cause of which originates in the gallbladder. Usually secondary to gallstone impacted at cystic duct

Choledocholithiasis - gallstone within the common bile duct (CBD) or hepatic duct. These can lead to obstructive jaundice, cholangitis, and pancreatitis. This can also occur in patients who have previously had a cholecystectomy.

Acute Cholecystitis - infection of the gallbladder, 90% of which is calculus cholecystitis secondary to gallstones. Rarely patients can have Acalculus cholecystitis secondary to sludge.

Acute Cholangitis (a.k.a ascending cholangitis) - infection within the biliary tree secondary to obstruction or stasis. 50 - 75% of patients with this condition will present with Charcot’s Triad - fever, abdominal pain & jaundice.

Risk Factors

Traditionally people use the 5F pneumonic to remember the patients most at risk of gallstone disease. The 5 F’s stand for;

• Female - especially if pregnant or on the OCP

• Fat (BMI > 30)

• Fair (Caucasian)

• Fertile - has had children

• Forty - Age > 40 yrs

Other risk factors include;

• Family history

• Bile Stasis e.g. in diabetic and cystic fibrosis patients

Risk Factors for Acute Cholangitis include;

• Gallstones

• Hepatobiliary malignancy

• Biliary tract manipulation or stenting

• Primary sclerosing cholangitis