Calculations of the Gallbladder

Biliary colic

Biliary Colic: The Most Common Complication of Gallbladder Stones

Biliary colic is the most frequent complication of lithiasis (presence of stones in the gallbladder and / or biliary tract). When they move from their place of origin, the stones can in fact go to obstruct the normal outflow of bile.

In particular, a large stone or several small stones can wedge into the cystic duct and obstruct it. This creates a sort of plug that prevents the contraction of the gallbladder and / or the emptying of the bile.

This condition generates intense pain, for some comparable to those experienced by women during labor.

Biliary colic is in fact characterized by a very violent pain that arises in the upper part of the abdomen, in the center or more frequently to the right under the ribs; subsequently the pain extends posteriorly until it reaches the lower tip of the scapula.

In addition to being very painful, this attack is also quite long-lasting since it can last from twenty thirty minutes up to six to twelve hours. Often, precisely because of its intensity, the pain is associated with nausea, profuse sweating and vomiting.

In many cases, biliary colic is related to acute cholecystitis, a "generic inflammation of the gallbladder which - when caused by the presence of stones in the gallbladder, and / or in the biliary tract - takes the name of" calculous cholecystitis ".

Other Complications

Other Complications of Gallbladder Stones

Unfortunately biliary colic is not the only complication of gallbladder stones nor the most serious.

Driven by the contractions of the gallbladder, a stone can in fact go down and obstruct the bile duct (the main duct that carries bile into the duodenum). Initially, this passage causes pain very similar to a banal colic. However, there is a fundamental difference between the two conditions: while in the case of simple colic, even though the gallbladder is excluded, the passage of bile coming from the liver is still possible, in case of obstruction of the choledochus this outflow is prevented.

The impossibility of disposing of the bile that inevitably remains at a systemic level determines, with the passage of time, the classic appearance of the jaundiced subject (yellow color of the skin and mucous membranes).

The stagnation of bile can also infect the gallbladder filling it with purulent material (pus). In this case we speak of empyema of the gallbladder.

Unfortunately, the terminal section of the choledochus narrows and is regulated by the presence of a sphincter, a kind of muscular ring that controls the passage of organic fluids. For this reason the calculation is unlikely to pass this barrier. Its stay in this area, in addition to preventing the biliary outflow, also hinders the passage of the juices produced by the pancreas. The consequent rise of bile in the pancreatic duct, associated with the sudden increase in pressure in the innermost ducts, can trigger acute pancreatitis (30-70% of cases, more frequent in women after 50-60 years).

If, on the other hand, a large stone pierces the wall of the choledochus and duodenum, wedging itself into the latter, an intestinal obstruction can occur.

Diagnosis

How are gallbladder stones diagnosed?

In most cases (about 80%), gallstones is asymptomatic and is discovered by chance in the course of other control investigations. The advent of abdominal ultrasound has allowed us to appreciate the real spread of this pathology until then. Today, statistics in hand, about 15% of the population has gallbladder stones.

The ultrasound of the upper abdomen is the simplest and most reliable type of diagnostic investigation. In fact, it allows to visualize the stones (even if they are not radiopaque), the state of the gallbladder wall and any dilations and / or stones of the main biliary tract (duct that carries bile directly from the liver to the intestine). unlike the old cholecystography, it does not administer any radiation to the patient and is totally devoid of other side effects.

In the presence of atypical symptoms, however, other pathologies affecting the digestive tract must be excluded (for example, peptic ulcer; gastroesophageal reflux; irritable bowel syndrome; etc.).

The ultrasound examination does not require the observance of particular preparations for the examination except fasting for at least 6/8 hours and, possibly, a diet low in waste in the previous two or three days. In this way we try to prevent intestinal bloating. , one of the main factors hindering diagnosis.