In this article, we will discuss the Treatment of Biliary Colic. So, let’s get started.
1. Relief of Pain: Several analgesic can be used to control the pain but pethidine I.M. or pentacozine I.M. are commonly employed. Morphine is best avoided as it increases intrabiliary pressure.
2. Treatment of bile duct stones: Urgent ERCP with sphincterotomy and stone extraction is generally indicated for bile duct stones complicated by acute cholangitis and it is followed by laparoscopic cholecystectomy within 72 hours. Before ERCP, liver function tests i.e. enzymes and PTI must be done and PT should be restored to normal by parenteral vitamin K. An alternative approach is laparoscopic cholecystectomy and bile duct exploration. Choledocholithiasis discovered at laparoscopic cholecystectomy may be managed via laparoscope or, if necessary, open bile duct exploration or by post-operative endoscopic sphincterotomy maybe attempted.
3. Treatment of cholangitis: Ciprofloxacin 500 mg I.V. every 12 hourly plus metronidazole 500 mg every 6-8 hourly is most effective regimen. The ciprofloxacin penetrates well into the bile. Alternative regimen includes I.V. ampicillin and sulbactam 3 g every 6 hourly; cefoxitin 1-2 g every 6 hourly or Ampicillin 2 g every 6 hourly plus gentamicin 80 mg every 8 hourly.
For severe or hospital acquired acute cholangitis: The antibiotic regimen includes I.V. piperacillin and tazobactam (3.375 g every 6 hourly), ticarcillin and clavulanate 3.1 g every 6 hourly or ceftriaxone and metronidazole combination.
Meropenam is used in high risk patients with antibiotic-resistant pathogens.
If medical therapy fails, decompression by a biliary stent or nasobiliary catheter can be done. After decompression, antibiotics are continued for another 3 days.