What are the key clinical features that differentiate biliary colic from other causes of abdominal pain?

Key clinical features that differentiate biliary colic from other causes of abdominal pain include:

• Nature and duration of pain: Biliary colic typically presents as a self-limiting attack of severe, steady pain lasting for hours, often in the right upper quadrant or epigastrium, which can be controlled with analgesia in primary care. This contrasts with other abdominal pains that may be more variable in duration and character ¹.
• Location and radiation: The pain is usually located in the right upper abdomen and may radiate to the back or right shoulder, which is characteristic of biliary colic ¹.
• Triggering factors: Pain is often precipitated by fatty meals due to gallbladder contraction stimulated by cholecystokinin release, which is less typical in other abdominal pain causes ¹.
• Absence of systemic signs: Unlike acute cholecystitis or other complications, biliary colic patients are generally not systemically unwell (no fever, sepsis, or jaundice) ¹,².
• Response to analgesia: Pain from biliary colic often responds well to NSAIDs such as diclofenac, whereas other causes may require different management ¹.
• Investigations: Ultrasound may show gallstones without signs of inflammation, differentiating biliary colic from acute cholecystitis or other pathologies ¹,².

In summary, biliary colic is characterized by episodic, severe right upper quadrant pain triggered by fatty food intake, lasting hours, without systemic illness, and responsive to NSAIDs, distinguishing it from other causes of abdominal pain ¹,².