Intended for healthcare professionals

Practice 10-Minute Consultation

Biliary colic

BMJ 2021; 374 doi: (Published 13 September 2021) Cite this as: BMJ 2021;374:n2085
  1. Sandra Hapca, academic foundation doctor, Aberdeen Royal Infirmary; honorary associate, Institute of Applied Health Sciences1,
  2. George Ramsay, consultant colorectal and general surgeon, Aberdeen Royal Infirmary; senior clinical lecturer, Health Services Research Unit 2,
  3. Peter Murchie, professor of primary care and lead of Academic Primary Care Research Group3,
  4. Irfan Ahmed, consultant HPB surgeon Aberdeen Royal Infirmary; honorary professor, University of Aberdeen 4
  1. 1University of Aberdeen School of Medicine and Dentistry, Foresterhill, Aberdeen AB25 2ZD, UK
  2. 2Health Services Research Unit, University of Aberdeen, Aberdeen
  3. 3Institute of Applied Health Sciences, Academic General Practice, University of Aberdeen, Aberdeen
  4. 4Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen
  1. Correspondence to: S Hapca

What you need to know

  • Arrange liver function tests and routine outpatient abdominal ultrasonography for all patients with suspected biliary colic

  • Acute, persistent, right upper quadrant pain, systemic upset, and Charcot’s triad are suggestive of complicated gallstones and indicate need for emergency hospital referral

  • The current recommended management of biliary colic is laparoscopic cholecystectomy, but this might not definitively treat symptoms in all patients. Some people might opt for conservative management, but they remain at risk of developing gallstone related complications

A 30 year old woman presents to her general practice with abdominal pain. It started suddenly yesterday evening and lasted for a few hours, but then it came on again in the morning. She says it feels like a tight band around her upper abdomen. She had a similar, less painful, episode a few weeks ago which resolved with over-the-counter analgesia. She is otherwise healthy and has intentionally lost 5 kg in the past six weeks.

This article outlines how to assess and manage a patient with suspected biliary colic in primary care. Areas covered include criteria for referral, investigations, and discussion of management options.

What you should cover

Abdominal pain is a common presenting symptom with many causes, as outlined in box 1. Gallstone pathology is an important differential. Box 2 describes the spectrum of clinical syndromes that can arise from gallstones.

Box 1

Differential diagnoses in a patient presenting with epigastric/right upper quadrant pain

  • Gastro-oesophageal—Oesophagitis, gastro-oesophageal reflux disease, gastritis, peptic ulcer, duodenal ulcer, functional dyspepsia

  • Hepato-biliary—Biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, chronic pancreatitis, acute hepatitis

  • Renal—Renal colic, pyelonephritis

  • Pulmonary—Basal pneumonia, pulmonary embolism

  • Others—Acute coronary syndrome, costochondritis, Fitz-Hugh-Curtis syndrome, pelvic inflammatory disease, shingles

Box 2

Spectrum of clinical syndromes caused by gallstones

  • Gallstone disease—All symptoms caused by gallstones, namely calculi in the gallbladder. The lifetime prevalence of gallstones in Europe is approximately 10-15%.1 Most are found incidentally. The incidence of gallstones increases with age, and gallstones are more prevalent in …

View Full Text

Log in

Log in through your institution


* For online subscription