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Liver colic
Medical expert of the article
Last reviewed: 05.07.2025
Hepatic colic is the most common clinical form of cholelithiasis (75% of patients). It manifests itself in sudden and usually periodically recurring intense pain attacks.
Among the most characteristic main manifestations that occur in connection with the formation of stones in the gallbladder is hepatic colic. Its occurrence, as the relevant medical statistics state, is noted with a certain periodicity in every tenth patient with gallstone disease, mainly in male patients. Women suffer from hepatic colic much less often, it appears in them with approximately half the frequency of recorded cases.
Hepatic colic occurs due to the fact that stones present in the gallbladder create an obstacle to the normal outflow of bile. This pathological phenomenon in the human body is accompanied by acute pains that occur in the area where the gallbladder is located, namely, on the right side under the costal arch. The right shoulder blade is also involved in the localization of pain syndrome in hepatic colic, and in addition, pain can sometimes radiate under the right collarbone. Pains in hepatic colic are of an acute burning nature, and can be provoked by both high-intensity physical activity and act as a consequence of strong emotional stress. Due to heavy physical exertion or an excited psycho-emotional state, the content of the hormone adrenaline in the blood increases, the excess of which leads to spasms in muscle tissue, as well as vascular spasms. This provokes stagnation of bile in the liver ducts, which in turn causes pain characteristic of hepatic colic.
Causes of hepatic colic
An attack of hepatic colic can be provoked by an error in diet or physical activity, but in many patients it is not possible to identify the provoking factors, and the pain can begin during night sleep. The mechanism of hepatic colic is complex and has not been fully studied. Most often, an attack of colic is caused by a violation of the outflow of bile from the gallbladder (GB) (spasm of the cystic duct, its obstruction by a stone, a lump of mucus) or a violation of the outflow of bile through the common bile duct (CBD) (spasm of the sphincter of Oddi, its obstruction by a stone, a lump of mucus, the passage of a stone through the CBD).
Different zones of the gallbladder and bile ducts are characterized by different pain reactions to the presence of a calculus. Three zones are usually distinguished:
- the bottom and body of the gallbladder are a “silent” zone (the presence of a stone in it does not cause pain in the absence of inflammation of the mucous membrane);
- zone of moderate sensitivity - the funnel, the neck of the gallbladder and the adjacent part of the body of the gallbladder (moving into this zone, the stone causes a violation of the outflow of bile; contraction of the gallbladder is accompanied by moderate pain);
- zone of acute pain (duct zone) - the presence of concretions in the ducts causes their spasm, accompanied by wall ischemia, impaired bile outflow, stretching of the overlying sections of the duct, hyperperistalsis, which is the cause of acute pain and increased spasm (vicious circle), continuing until the passage of the concrement, mucus clot or the introduction of antispasmodics. It is not recommended to introduce true opiate receptor agonists (morphine, fentan, promedol, etc.), which can increase the pain syndrome (sphincter spasm is possible).
Symptoms of hepatic colic
The following clinical symptoms are characteristic of hepatic colic: an attack occurs suddenly, can last for hours, rarely more than a day. The pain is acute, paroxysmal, unclearly localized in the right hypochondrium and epigastrium - visceral pain (occurs with spasm, stretching, swelling of organs). Irradiation of pain to the back or shoulder blade is caused by irritation of the endings of the branches of the spinal nerves involved in the innervation of the hepatoduodenal ligament along the bile ducts. The noted symptoms may be associated with the presence of choledocholithiasis, cholangitis, ductal hypertension - the so-called choledochial colic. The attack may be accompanied by reflex vomiting, which does not bring relief. The pulse may be rapid, blood pressure does not change significantly. There is no increase in temperature, chills, or leukocytosis, since there is no inflammatory process (unlike an attack of acute cholecystitis). The pain usually increases over 15-60 minutes, and then remains almost constant for 1 to 6 hours. Subsequently, a gradual decrease in pain is noted, but a sudden cessation is also possible. An attack of pain lasting more than 6 hours may indicate the possible development of acute cholecystitis. Between attacks of hepatic colic, the patient feels quite satisfactory. In 30% of patients, repeated attacks are not observed.
Acute hepatic colic
Acute hepatic colic occurs mainly against the background of gallstone disease. To a slightly lesser extent, its occurrence can be provoked by dyskinesia of the biliary tract. The fundamental factor in the process of development of prerequisites for the occurrence of acute hepatic colic is the blockage of the bile outflow paths from the gallbladder by stones formed in it. Because of this, the amount of bile increases significantly, causing the gallbladder to stretch in that part of it that is located above such an obstacle, creating the impossibility of free outflow from this organ.
Acute hepatic colic can be caused by eating too much food, especially if it is too fatty, by excessive use of hot spices, herbs, and by intemperance in relation to alcoholic beverages. In addition, painful symptoms of this kind can appear as a result of too intense physical exertion of the body.
The following symptoms are characteristic of acute hepatic colic. It may be preceded by nausea, a feeling of heaviness in the pit of the stomach or in the right hypochondrium. In these areas of the body, a sudden onset of pain of an acute nature is noted. In addition, pain may occur in the right shoulder and shoulder blade, and spread to the neck. In some cases, the localization of the pain syndrome, extending from the hypochondrium, completely covers the abdomen.
The pain associated with acute hepatic colic is very intense and can be constant or manifest as contractions.
The duration of an attack can be equal to several minutes or hours, or continue for a period of time exceeding a whole day. In acute hepatic colic, patients, as a rule, become extremely excited, turn pale, sweat and are very restless, trying to find a body position in which relief can occur.
Acute hepatic colic calls for the need to immediately take appropriate therapeutic measures to help the patient cope with such a critical condition.
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Attack of hepatic colic
An attack of hepatic colic occurs against the background of cholelithiasis and is also called biliary or cholelithic colic. Attacks of hepatic colic are mainly observed at that stage of the disease with the formation of stones in the gallbladder, at which the undeniable clinical manifestations of this disease become clearly expressed. The previous two stages are mainly characterized by an asymptomatic course and the absence of pain syndrome. For cholelithiasis, when it reaches its third stage in the process of developing pathological progress, it is characteristic to alternate fairly long periods, during which the disease practically does not manifest itself in any way, with episodic attacks of hepatic colic. Over a long period of time, all the symptoms can be reduced to nothing more than a feeling of heaviness in the right hypochondrium, minor discomfort after eating and the appearance of a bitter taste in the mouth. And sometimes even such manifestations may not be observed. But such a lull in the course of the disease is only for a time, and sooner or later, one way or another, one must expect the occurrence of an attack of hepatic colic.
Due to the fact that with the course of the pathological process of gallstone formation, stagnation becomes more and more pronounced, pain symptoms are characterized by ever-increasing intensity. They appear against the background of the fact that the lumen of the common duct is blocked by a stone or significantly narrows due to a spasm. This leads to excessive accumulation of bile inside the gallbladder, which increases in size, stretches, and this process is accompanied by pain. Attacks of hepatic colic can also occur when stones move in the bile ducts.
An attack of hepatic colic from the very first moment as soon as it appears, signals that gallstone disease, if it was previously present in a person asymptomatically and did not manifest itself in any way, its presence was not established, now it makes itself known quite clearly and with all certainty. It is with an attack of hepatic colic that the development of all kinds of complications of this disease mainly begins.
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Liver colic during pregnancy
Hepatic colic during pregnancy may be caused by the fact that a woman in position had some chronic diseases or disorders of internal organs functioning associated with the processes of bile outflow even before she began to bear a child. Among the causes of hepatic colic in this regard, one can name in particular cholelithiasis and dyskinesia of the biliary tract. In this case, hepatic colic occurs as a consequence of exacerbation of such diseases during pregnancy.
An unplanned and ill-considered approach to organizing the diet of a woman preparing to become a mother can also lead to the appearance of liver colic during pregnancy. In this case, it is necessary to consult a doctor to optimize the diet. You should avoid eating those foods and dishes that can negatively affect the normal functioning of the liver. It is advisable to refrain from everything spicy, fried, and exclude all smoked foods from your menu.
When a woman suffers from hepatic colic during pregnancy, she often has difficulty finding a body position that would reduce the intensity of the pain. The pain of hepatic colic during pregnancy is very sharp and aching and may be accompanied by an increase in body temperature, nausea and vomiting. In order to cope with hepatic colic during pregnancy, it is not recommended to take any pharmacological painkillers, since their use will not benefit the functions of the liver.
The best way to overcome hepatic colic during pregnancy is probably walking barefoot, which stimulates the feet, which in turn has a beneficial effect on relaxing the muscles of the gallbladder and bile ducts. Taking antispasmodic drugs is also justified to relieve spasms.
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Emergency care for hepatic colic
Emergency care for hepatic colic involves, on the one hand, the use of agents that help reduce the severity of pain, and on the other, ensuring the restoration of the patency of the bile duct by relieving tension in its muscles.
Nitroglycerin in an alcohol solution or in tablet form shows a high degree of effectiveness as an antispasmodic drug. The patient needs to take either one tablet or a solution in the amount of 2 drops. Sometimes this measure is not enough. In this case, it is necessary to inject platifillin subcutaneously in a 0.2% solution of 2 ml or from 2 to 3 milliliters of papaverine solution in a concentration of 2%. An alternative can be a subcutaneous injection of a 0.1% solution of atropine 1 milliliter. This drug can be used in combination with each of the two above. Good results in terms of spasm relief are achieved by using arpenal, which should be injected subcutaneously in a 1-milliliter dose of a 2% solution.
To relieve pain, an injection of 1.0 aspirin or analgin in a similar dose is given. Repeated use of these drugs at a 4-hour interval is allowed.
It is recommended to keep a heating pad in the area where the gallbladder is located. It should not be filled with too much water, so as not to subject the peritoneal wall to significant pressure. When possible, the patient with hepatic colic can be placed in a bath with water of a fairly high temperature for 10-15 minutes.
If hepatic colic is accompanied by fever in the patient, he is shivering, and the elevated temperature persists for more than one day, antimicrobial agents are prescribed, for example, the introduction of 500,000 streptomycin twice during the day. As an option, 1.0 sulfadimidine with a 4-hour interval can also be considered.
As we can see, emergency care for hepatic colic has two main vectors of treatment. The essence of medical measures in connection with it is to eliminate the spasm in the bile duct that prevents the normal outflow of bile, as well as to reduce the intensity of pain symptoms associated with its excess content in the gallbladder.
First aid for hepatic colic
Before taking any independent measures to help with hepatic colic, it is necessary to take into account that if the pain is of a protracted nature and does not stop after 5 to 6 hours, this requires immediate medical attention. This situation means that the disease automatically becomes surgical. That is, it becomes such that monitoring the person's condition, diagnosis and treatment should be entrusted to a surgeon. Since often the only effective treatment method can only be surgical intervention. Thus, if hepatic colic does not go away for a long time, such a patient needs to be hospitalized.
As for how one can help relieve suffering during an attack, there are a number of practical recommendations on what pre-hospital care should be for hepatic colic.
The minimum program in this case assumes, first of all, that such a patient needs to be provided with bed rest. Then he is offered to take painkillers (1-2), a couple of papaverine or no-shpa tablets, and validol under the tongue.
It should be noted that the use of a heating pad is not always justified. It is advisable only in the situation where one can be absolutely and unequivocally sure that it is hepatic, biliary colic, while there is no acute cholecystitis. And only a doctor is competent in this matter.
So, having done the above, you should definitely call for emergency medical care. Especially if the attack happened for the first time. This is all the pre-hospital care for hepatic colic, and further treatment should be transferred to the hands of doctors.
How to relieve hepatic colic?
When an attack of acute pain in the liver and gallbladder occurs, the question of what needs to be done in such a case and how to relieve hepatic colic becomes especially relevant? Since such a phenomenon is most directly caused by the appearance of stagnant processes, in order to alleviate the patient's condition with hepatic colic, the primary measure is a series of actions aimed at ensuring the free outflow of bile in the hepatic ducts and gallbladder.
This can be achieved using pharmacological preparations with antispasmodic properties. In particular, the use of drotaverine, no-shpa, papaverine, platifillin is justified. In particularly severe cases, it may be necessary to administer them intramuscularly, as well as intravenously.
The use of a heating pad applied to the right side is also one of the measures that are appropriate for hepatic colic. However, it is important to remember that this measure is only allowed if there is complete certainty that this is not an acute attack of appendicitis.
Another way that can help normalize the processes of bile outflow is to completely abstain from food during the period of time until all the food in the body is completely digested.
When liver colic occurs, drinking mineral water from which all gases have been released can be useful.
In addition, 2 to 3 Allochol tablets can also help cope with hepatic colic.
Thus, although there are a sufficient number of various means and methods for relieving hepatic colic, nevertheless, if, as a result of their use, it is not possible to relieve pain for more than half an hour from the onset of the attack, this requires an immediate call for emergency medical care. But even in the case of successful self-relief of hepatic colic, you should not postpone a visit to a medical specialist who will be able to outline the range of possible causes leading to its occurrence and subsequently establish an accurate diagnosis.
Pain reliever for hepatic colic
So, what remedies can help cope with sudden acute burning pain in the liver and what can be used as an effective pain reliever for hepatic colic?
In the case of a severe attack, painkillers and antispasmodics are administered by injection or intravenous administration. Only a medical specialist can prescribe and perform such manipulations. As for what should be done until the ambulance team arrives, there are a number of specific recommendations that can help alleviate the patient's suffering.
It is often possible to successfully reduce the severity of pain syndrome in hepatic colic with the help of nitroglycerin, a tablet of which should be placed under the tongue. An alternative way of taking this drug can be a few drops (2-3) of it on a piece of refined sugar.
If attacks of hepatic colic have occurred before and the patient has previously sought medical help for this reason, it makes sense to use the specific painkillers that are included in the doctor’s prescriptions to relieve the pain.
Rectal suppositories with papaverine and those containing belladonna extract are available over-the-counter pain relievers. However, it should be noted that you should not resort to them until you have consulted a doctor. Since they are, in particular, contraindicated in glaucoma.
If the pain is not too severe, it is recommended to take a 0.1% atropine solution of 5 to 10 drops per tablespoon of cold water. Atropine is a prescription drug.
Among the acceptable measures, the possibility of using a warming compress or a non-hot water bottle in the upper abdomen is also not excluded. However, when placing the water bottle, it is necessary to take into account that if after 5-10 minutes of time there is no improvement from the heat, it must be removed.
A painkiller for hepatic colic can bring some relief to the patient, but one should not forget that such pain is a symptom accompanying a malfunction of the gallbladder and a violation of the processes of bile outflow in the hepatic duct. And this calls for the need to treat the underlying disease first.
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Diet for hepatic colic
Hepatic colic is closely related to liver and biliary tract diseases. Nutrition for hepatic colic should be organized based on general recommendations regarding the principles on which to build a meal plan and select a menu for these diseases.
The diet, when there is hepatic colic, should include a sufficient amount of complete, easily digestible protein. The fundamental factor on the basis of which the required content and quality of fats are calculated is the general condition of the patient in each specific case. In order for the diet to acquire properties that promote the activation of bile processes, when there is such a need, it is necessary to include in it an increased amount of fats of plant origin.
Regarding the extent to which carbohydrates should be included in the diet, there is a rule according to which they should not be in excess of the amount regulated by the physiological norm. If the patient is overweight, then carbohydrates may be present in the diet in reduced quantities.
The method of cooking plays an important role in terms of how to achieve the greatest sparing of the digestive tract. In this regard, the optimal culinary treatment is by boiling, mashed or chopped food. Better digestion and absorption is greatly facilitated by eating small amounts of food at short intervals. This principle of fractional nutrition improves intestinal motility, and in addition produces a remarkable choleretic effect.
Normalization of bile outflow also occurs due to the presence of foods in the diet that are rich in dietary fiber. Due to this, cholesterol is intensively excreted in the feces.
Nutrition for hepatic colic, as is obvious, has as its main goal to promote normalization and bring to an optimal state the functioning of the gastrointestinal tract, liver, gall bladder and bile ducts. As a result, the likelihood of the occurrence of characteristic acute attacks of pain decreases.
Diet for hepatic colic
Diseases of the liver and biliary tract, if we exclude congenital defects of heredity, consequences of acute infections, metabolic disorders with the formation of stones in the gallbladder, arise and become chronic often against the background of excessive consumption of alcoholic beverages and an irrationally organized diet. Systematic irregular food intake, an unbalanced menu in which there are no proteins and necessary vitamins in sufficient quantities can provoke dysfunction of the liver and gallbladder.
The diet for hepatic colic after the pain symptoms have been successfully removed should be based on the principle of reducing the possibility of such attacks in the future as much as possible. During the first few weeks after hepatic colic, it is necessary to refuse to eat meat and animal fats, as well as eggs. A suitable replacement for these products can be boiled fish, vegetable oil, cottage cheese. You can diversify the menu by adding an increased amount of boiled vegetables to it.
In the future, by strictly adhering to certain dietary prescriptions, it becomes possible to minimize the likelihood that hepatic colic will occur.
Diet No. 5 is usually taken as a basis for diseases of the liver and biliary tract. According to it, the energy value of dishes should be calculated based on physiological norms, it is recommended to avoid overeating. The physiological norm of proteins is 1 gram per kilogram of body weight, which is optimal. Moreover, about half of their total amount should be represented by proteins of animal origin: meat, poultry, fish, dairy products, eggs.
The diet is composed of a ratio of two-thirds animal fats to one-third vegetable fats, from a total daily intake of 70-80 grams.
When following a diet for hepatic colic, you should not overuse fatty and spicy foods, refrain from smoked and pickled foods, and exclude foods with a high cholesterol content. A reasonable approach to drinking alcoholic beverages is also important.
A diet for hepatic colic is selected based on medical recommendations and prescriptions, taking into account the stage to which the underlying disease has progressed and based on the general condition of the patient.
Hepatic colic, therefore, has as its prerequisites the presence of certain factors of pathogenic nature, and its occurrence occurs exclusively on their basis. In the absence of health disorders and normal functioning of the liver and gall bladder, it does not appear.
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