Confirmed with AMBOSS
Support w/ adding dull as well
support
Support. @anking-maintainers
UW Qid check please?
#AK_Step3_v12::#UWorld::9959
#AK_Step1_v12::#UWorld::Step::1319
#AK_Step2_v12::#UWorld::Step::4433 → supports saying “despite the name biliary colic is constant (not colicky)”
Support but don’t like the asterisk format. It’s not a common format we use
Agree, I went in and updated the formatting
I’m not sure about this. I get that AMBOSS has this definition (that’s clear), but this is inconsistent with what I’ve come to understand about biliary colic from the NBME (I’ve pasted two examples below) and is not what most people mean when they say “biliary colic.” Even googling “biliary colic,” the results include “waxing and waning” quality (see screenshot below). I’m open to having my mind changed, I just need to see more than the AMBOSS article.
NBME CCSSA 13 (Section 2, Q2): “This patient has evidence of gallstones and episodic pain that self-resolves, which is consistent with biliary colic.”
Medicine Form 4 (Q42): “Obstructive choledocholithiasis results in colicky right upper quadrant or epigastric pain (biliary colic), nausea, vomiting, and increased direct bilirubin and alkaline phosphatase.”
Anyone have access to the UWorld medical library?
UWorld Medical Library: “Biliary colic pain is typically episodic, located in the right upper quadrant (RUQ) or epigastrium, and radiates to the shoulder (eg, referred pain from diaphragmatic irritation). There may be associated nausea and vomiting. Biliary colic pain usually follows a meal with high fat content (eg, due to CCK release) and resolves in minutes to hours. This pain is typically due to contraction of the gallbladder against a transiently obstructed gallbladder outlet (usually by a mobile gallstone). The pain will resolve when the gallbladder relaxes, the gallstone moves, and the intra-gallbladder pressure decreases.”
I think that’s why, in the extra, we said “not typically colicky” to allow for the possibility of it being colicky. But since there is conflicting info, we could just remove the pain descriptor entirely and say in the extra “pain is usually constant, but may be colicky (waxing and waning)”
Does the “episodic” nature contradict the “constant” descriptor?
That’s an interesting option. And could just change the Text to something like “Biliary {{c1::colic}} is characterized by {{c1::right upper}} quadrant pain associated with…” ?
It’s probably most elegant solution. We can discuss it in the slack too since this is a pretty important topic.