Illness script
Biliary Colic
Postprandial RUQ pain after fatty meals that resolves within hours, without fever or inflammation.
This illness script for Biliary Colic covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Classic '4 Fs': Female, Forty, Fertile, Fat
- More common in women and with pregnancy/estrogen use
- Risk: obesity, rapid weight loss, Native American ethnicity
- Family history of gallstones
- Diabetes, hemolytic anemia (pigment stones)
02
Diagnostics & workup
- History: episodic RUQ/epigastric pain after fatty meals
- Pain constant, lasts 30 min to a few hours, then resolves
- May radiate to right scapula/shoulder; nausea common
- Exam: no fever, no Murphy's sign, nontender or mildly tender
- RUQ ultrasound is first-line: shows gallstones
- Normal LFTs, normal WBC (distinguishes from cholecystitis)
03
Pathophysiology
- Gallstones transiently obstruct cystic duct
- Gallbladder contracts against obstruction (fatty meal → CCK release)
- Increased wall tension causes visceral pain
- Stone falls back, obstruction relieved → pain resolves
- No inflammation or infection (unlike cholecystitis)
04
Treatment
- Analgesia: NSAIDs (ketorolac) first-line, or opioids
- Elective laparoscopic cholecystectomy is definitive treatment
- Dietary modification: avoid fatty meals as temporizing measure
- Ursodeoxycholic acid if surgery not an option (limited efficacy)
- Disposition: outpatient; educate on warning signs of complications
- Watch for progression to cholecystitis, choledocholithiasis, pancreatitis
Keep reading
Full library- Bacterial VaginosisReproductive-age woman with thin, gray, malodorous ('fishy') vaginal discharge and no significant inflammation.
- Ectopic PregnancyReproductive-age woman with amenorrhea, unilateral pelvic pain, and vaginal bleeding plus positive pregnancy test.
Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.