Ultrasound of Upper Abdominal Pain Biliary Colic

Clinical manifestations: Episodes of severe, colicky pain due to gallbladder contractions. The cause is a stone obstructing the bile ducts and raising the pressure within the gallbladder. The pain often occurs after meals and lasts for 1–4 hours (residual complaints may persist for 24 hours). Vomiting is common, and jaundice may occur with duct occlusion. Fever signifies a complication.

Diagnosis:
x History: Many patients have a prior history of gallstones.
x Laboratory tests may show signs of cholestasis with elevated bilirubin, GGT, and AP.
x Sonography.

Sonographic findings:
x Stone: Hyperechoic with an associated acoustic shadow.
x Often difficult to define a stone within the bile duct.
x Acoustic shadow may indicate the presence of a stone.
x With an obstructed duct, look for a stone:
– Common duct stone leads to ductal dilatation
– Infundibular or cystic duct stone leads to gallbladder hydrops (marked gallbladder enlargement and tenderness).
– Prepapillary stones may obstruct the pancreatic duct and incite pancreatitis.

Duct stone. The bile duct (BD) is obstructed. An acoustic shadow (S) indicates the presence of the intraductal stone (cursors). GB = gallbladder, VC = vena cava

Accuracy of sonographic diagnosis: The cause of biliary colic can be diagnosed sonographically with i 90% accuracy. With atypical findings (small gallbladder), the diagnostic accuracy falls to 65%. Additional imaging modalities are necessary only in exceptional cases (e.g., radiographs for distinguishing a porcelain gallbladder from gallstones).

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