Biliary Colic & Chronic Cholecystitis

Biliary Colic

1. pathogenesis

   • temporary GB occlusion 2/2 stones/sludge

2. clinical

   • post-prandial pain esp. w/fatty meals (50%)

   • RUQ/epigastric pain w/wo radiation to back/shoulder

   • constant dull but intense pain lasting < 6 h

3. diagnosis

   • clinical sx + gallstones/sludge on imaging

4. therapy

   • intractable pain: urgent lap chole

   • not intractable: elective lap chole

5. complications

   • acute or chronic cholecystitis

   • choledocholithiasis w/wo cholangitis

   • Mirizzi syndrome w/wo gallstone ileus

   • GB cancer

Chronic Cholecystitis

1. pathogenesis

   • recurrent biliary colic → scarring → fibrosis

2. clinical

   • repeated episodes and/or hx of biliary colic

3. diagnosis

   • clinical sx + gallstones/sludge on imaging

4. therapy

   • elective lap chole