GALL STONE COLIC

Colic is defined as a severe abdominal pain caused by spasm, obstruction, or distention of any of the hollow viscera. And when it occurs due to gallstones that are present in gall bladder or bile duct then it is known as gall stone colic. It is also known as biliary colic. It is the most common symptom of gallstones.

Causes of formation of gallstones:
Gallstones are stones that form in the bile. There are several types of gallstones and each type has a different cause.

Cholesterol gallstones
Cholesterol gallstones are made primarily of cholesterol. They are the most common type of gallstone. Cholesterol is the substance that liver cells secrete into bile. Cholesterol is a fat and it do not dissolve in the bile in order to dissolve it liver secrete bile acids and lecithin in the bile. If the liver secretes too much cholesterol for the amount of bile acids and lecithin it secretes, some of the cholesterol does not dissolve. Similarly, if the liver does not secrete enough bile acids and lecithin, some of the cholesterol also does not dissolve. In either case, the undissolved cholesterol sticks together and forms particles of cholesterol that grow in size and eventually form larger gallstones.

Pigment gallstones
Pigment gallstones are the second most common type of gallstone. There are two types of pigment gallstones.
1)Black pigment gallstones, and
2)Brown pigment gallstones.
Black pigment gallstones: If there is too much bilirubin that do not dissolve in bile, and combines with calcium, to form pigment gallstones (so-called because it is dark brown in color). And in this manner black pigment gallstones formed because they are black and hard.
Brown pigment gallstones: If there is reduced contraction of the gallbladder or obstruction to the flow of bile through the ducts, bacteria may ascend from the duodenum into the bile ducts and gallbladder. The bacteria alter the bilirubin in the ducts and gallbladder, and the altered bilirubin then combines with calcium to form pigment. The pigment then combines with fats in bile (cholesterol and fatty acids from lecithin) to form particles that grow into gallstones. This type of gallstone is called a brown pigment gallstone because it is more brown than black. It also is softer than black pigment gallstones.
Other types of gallstones: Other types of gallstones are rare. Perhaps the most interesting type of gallstone is the gallstone that forms in patients taking the antibiotic, ceftriaxone (Rocephin). Ceftriaxone is unusual in that it is eliminated from the body in bile in high concentrations. It combines with calcium in bile and becomes insoluble. Like cholesterol and pigment, the insoluble ceftriaxone and calcium form particles that grow into gallstones. Fortunately, most of these gallstones disappear once the antibiotic is discontinued; however, they still may cause problems until they disappear. Another rare type of gallstone is formed from calcium carbonate.

Risk factors:
Cholesterol Stones:
1.Gender- More common in females then males.
2.Age- its prevalence increases with age.
3.Obesity
4.Pregnancy
5.Birth control pills and hormone therapy
6.Rapid weight loss
7.Inflammatory bowel diseases- Crohn's disease, ulcerative colitis.
8.Increase blood triglycerides.

Pigment stones-
Black pigment gallstones form whenever there is an increased load of bilirubin that reaches the liver. This occurs whenever there is increased destruction of red blood cells, as there is in sickle cell disease and thalassemia. Black pigment gallstones also are more common among patients with cirrhosis of the liver. Brown pigment gallstones form when there is stasis of bile (decreased flow), for example, when there are narrow, obstructed bile ducts.

Symptom:
Characteristically, biliary colic comes on suddenly or builds rapidly to a peak over a few minutes.

• It is a constant pain, it does not come and go, though it may vary in intensity while it is present.
• It lasts for 15 minutes to 4-5 hours. If the pain lasts more than 4-5 hours, it means that a complication - usually cholecystitis - has developed.
• The pain usually is severe, but movement does not make the pain worse. In fact, patients experiencing biliary colic often walk about or writhe (twist the body in different positions) in bed trying to find a comfortable position.
• Biliary colic often is accompanied by nausea.
• Most commonly, biliary colic is felt in the middle of the upper abdomen just below the sternum.
• The second most common location for pain is the right upper abdomen just below the margin of the ribs.
• Occasionally, the pain also may be felt in the back at the lower tip of the scapula on the right side.
• On rare occasions, the pain may be felt beneath the sternum and is mistaken for angina or a heart attack.
• An episode of biliary colic subsides gradually once the gallstone shifts within the duct so that it is no longer obstructing.