Synopsis
Recognise uncomplicated biliary pain, separate it from inflammatory or obstructive emergencies, investigate the biliary tree logically and arrange definitive treatment for symptomatic stones.
- Biliary colic is usually a steady epigastric or right-upper-quadrant pain lasting from roughly half an hour to several hours, often with nausea and sometimes radiating to the right scapula or back.
- Pain that persists, fever, rigors, jaundice, hypotension, confusion, peritonism or repeated vomiting is not reassuring biliary colic; assess urgently for cholecystitis, cholangitis, pancreatitis or another abdominal emergency.
- NICE recommends liver blood tests and transabdominal ultrasound when gallstone disease is suspected; a normal examination between episodes does not invalidate a characteristic history.
Key red flags
Pain continuing beyond the expected attack, fever and local guarding or a convincing Murphy sign indicate sustained cystic-duct obstruction with inflammation rather than simple biliary colic.
Investigation priorities
Identify cholestasis, hepatocellular injury and biochemical evidence that disease may extend beyond the gallbladder.
Management branches
A characteristic attack has resolved and there are no inflammatory, obstructive or systemic danger features.
- Confirm the symptom chronology, examine after analgesia, check liver blood tests and arrange or review a high-quality abdominal ultrasound.
- Offer appropriate oral analgesia, hydration and individual food-trigger advice while checking contraindications, pregnancy and current medicines.
Key medicines
Non-steroidal anti-inflammatory analgesicUse one formulary NSAID at the lowest effective adult dose for the shortest necessary course, checking the current BNF.
ParacetamolUse the current BNF adult oral or intravenous regimen, reducing exposure in low body weight, malnutrition or hepatic risk.