 So in this video, we're going to discuss biliricolic. So gallstone disease is an overarching term, and most commonly we'll find uncomplicated gallstone disease in the form of biliricolic. In a previous video, I mentioned that about 9% of women and 6% of men will develop gallstones. Fortunately, remember, most of those are asymptomatic. So you are in an oral exam, a clinical exam, or faced with a patient. What are you going to talk about when it comes to biliricolic? Let's start off with the incidence. Only about 15% of patients with gallstones will develop biliricolic. Once a patient has developed biliricolic, though, they have an 85% chance of repeated attacks. They also have about a 2-3% incidence per year of complicated disease, that's cholecystitis and other complications. So why do patients develop biliricolic? Well, food enters the duodenum from the stomach. Cells in the duodenal wall secrete cholecystokinin. It circulates in the bloodstream and acts on the smooth muscle cells in the gallbladder wall causing contraction. The stone blocks the flow of bile from the cystic duct and that severe contraction of the gallbladder causes tremendous pain. Of course, this usually follows the intake of a meal, especially a fatty meal. Most patients consume the largest meal at dinner in the evening, so they'll get pain during the night. Nausea and vomiting can accompany biliricolic. The pain is typical in the right upper quadrant and usually lasts for about half an hour up to several hours. If it lasts longer though, really do consider cholecystitis. The pain is relieved as the stone dislodges from that opening of the cystic duct allowing for emptying of the gallbladder. When a patient comes to hospital, it's important to confirm the diagnosis and that is usually done through ultrasound. Ultrasound is a good examination to visualize the gallstones and also complications of gallstone disease such as thickening of the wall, pericolus cystic fluid or even perforation of the gallbladder. Biliricolic though is uncomplicated gallstone disease. So usually on the ultrasound, we will not find those signs of complication, only the presence of gallstones. In patients with very typical symptoms without any gallstones, please remember to bring them back in two weeks time to repeat that ultrasound in case of missed stones. It is important to provide these patients with good analgesics. Non-steroidal anti-inflammatory drugs have been shown to be very effective. Of course, they are contraindications for the use of these drugs, so don't give them to patients at risk for or with peptic ulcer disease and also not in the dehydrated patient. Morphine is safe to use in these patients. It really does not cause more contraction of the distinctive body than any other opioid. Once your task of relieving the patient's pain is done, please do some further investigations. We really do need some blood tests. We need to see whether the patient's white cell count is elevated. That would be in the case of colisostitis. Also look at the liver enzymes and the bilirubin levels as well as the lipase to rule out pancreatitis. Urea and electrolyte levels can be used to determine whether a patient needs intravenous fluids and replacement of lost electrolytes in case they vomited a lot. The definitive treatment of bilirucolic is a colisostectomy. Now, it's not an absolute emergency, so that colisostectomy can usually be done on the next elective list. So why do we do a colisostectomy for a patient with bilirucolic? Well, we've already mentioned that they have a high incidence of repeated attacks and a 2 to 3% incidence per year of complicated disease. And really, this complication risk is higher than the risk for complications during a laparoscopic colisostectomy. Of course, there are always patients who are unfit for surgery and who refuse surgery. In these cases, we'll do expectant management and that is through simple analgesics. Patients can take these simple analgesics when they have an attack. Of course, do tell them that when the pain persists, they should come to hospital because they might have acute colisostitis. The solution therapy of the gallstones have been reported. Unfortunately, in most cases, it will not work. External beam lithotripsy, where we try to break up the stone with shock waves, has no role to play in the management of gallstones. While most patients have cholesterol stones, the management of hypercholesterolemia will have no effect on the outcome of the gallstone disease. I hope you found this informative. If you have any comments, please leave them down below. Also, subscribe to this channel and hit that notification bell so that when I do release new videos, you'll be the first one to find out about it.