Contributor: Jorge Chalit-Hernandez, OMS3

• Typically presents with biliary colic

• Right upper quadrant abdominal pain lasting more than 30 minutes and subsiding over several hours

• Often associated with fatty meals but not always

• Must rule out other causes of pain

• Peptic ulcer disease - typically presents with epigastric pain

• Pancreatitis - pain that radiates to the back or family history of pancreatitis

• Laboratory workup 

• LFTs including ALT, AST, and alkaline phosphatase are within the reference range

• Lipase and amylase within the reference range

• Imaging workup

• RUQ ultrasound is unremarkable

• Upper endoscopy with ultrasound can help rule out peptic ulcer disease and small stones

• HIDA scan may show a reduced gallbladder ejection fraction below 30-35% or it may be normal 

• Opiates may give false-positive results

• Opiates can sometimes make biliary colic worse due to their contractile effect on the sphincter of Oddi

• Some patients may benefit from surgical intervention i.e. cholecystectomy

• Classic biliary-type pain (best predictor of response to cholecystectomy)

• Pain for > 3 months duration

• Positive HIDA scan

References

1. Alhayo S, Eslick GD, Cox MR. Cholescintigraphy may have a role in selecting patients with biliary dyskinesia for cholecystectomy: a systematic review. ANZ J Surg. 2020;90(9):1647-1652. doi:10.1111/ans.16003

2. Arshi J, Layfield LJ, Esebua M. Mast cell infiltration and activation in the gallbladder wall: Implications for the pathogenesis of functional gallbladder disorder in adult patients. Ann Diagn Pathol. 2021;54:15 1798. doi:10.1016/j.anndiagpath.2021.151798

3. Carr JA, Walls J, Bryan LJ, Snider DL. The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech. 2009;19(3):222-226. doi:10.1097/SLE.0b013e3181a74690

4. Joehl RJ, Koch KL, Nahrwold DL. Opioid drugs cause bile duct obstruction during hepatobiliary scans. Am J Surg. 1984;147(1):134-138. doi:10.1016/0002-9610(84)90047-3

5. Mahid SS, Jafri NS, Brangers BC, Minor KS, Hornung CA, Galandiuk S. Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. 2009;144(2):180-187. doi:10.1001/archsurg.2008.543

Summarized & Edited by Jorge Chalit, OMS3

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