Biliary Colic and Cholecystitis: Understanding Gallstone Attacks

Biliary colic and cholecystitis are two of the most common reasons people present to hospital or their GP with sudden, severe pain under the right ribs. Both conditions begin the same way, with a gallstone blocking the flow of bile, but they differ in how long that blockage lasts and what it leads to. Understanding the difference can help you recognise when a gallbladder attack needs urgent attention and when it is likely to settle on its own.

What are Biliary Colic and Cholecystitis?

Both conditions arise from gallstones, hardened deposits that form in the gallbladder when bile contains too much cholesterol, bile salts or bilirubin. The gallbladder is a small pouch beneath the liver that stores bile and releases it into the small intestine to help digest fatty food. When a stone temporarily blocks the cystic duct, the narrow tube leading out of the gallbladder, pressure builds inside the gallbladder and causes sudden pain. This is biliary colic. If the blockage does not clear and the gallbladder wall becomes inflamed, sometimes with infection, the condition is called cholecystitis.

The two conditions sit on a spectrum of the same underlying process. Biliary colic is generally a shorter, self-limiting episode, while cholecystitis represents ongoing inflammation that usually requires hospital treatment. Recognising which one you are experiencing is an important part of deciding how urgently you need care.

What Causes These Gallbladder Attacks?

Gallstones blocking the cystic duct are responsible for the vast majority of both biliary colic and cholecystitis episodes. As bile continues to be produced but cannot drain normally, pressure and inflammation build within the gallbladder. Attacks are often triggered or worsened after a fatty meal, when the gallbladder contracts to release bile and pushes a stone against the duct opening.

Less commonly, cholecystitis can occur without any gallstones being present. This form, known as acalculous cholecystitis, tends to affect people who are already critically unwell in hospital, for example following major surgery, trauma or a serious infection elsewhere in the body. The risk factors for developing gallstones themselves, such as being overweight, having a family history of gallstones or losing weight rapidly, are covered in more detail on our gallstones page.

Recognising the Symptoms

The Pain Pattern of Biliary Colic

Biliary colic typically presents as a sudden, intense pain in the upper right or central abdomen, which may spread to the back or right shoulder blade. It often begins within an hour of eating a fatty meal and can last anywhere from a few minutes to several hours before easing as the stone shifts away from the duct opening. Unlike cholecystitis, biliary colic does not usually cause fever, and there is no ongoing inflammation once the episode has resolved. Between attacks, most people feel entirely well.

When Pain Signals Cholecystitis

Cholecystitis should be suspected when the pain does not settle within a few hours and is accompanied by other signs of illness. These include fever, nausea, vomiting, loss of appetite and pain that worsens with movement or deep breathing. Jaundice, a yellowing of the skin and eyes, affects up to one in ten people with cholecystitis and suggests the bile ducts may also be involved. Because cholecystitis reflects genuine inflammation and possible infection of the gallbladder, it is considered a more serious condition than biliary colic and needs prompt medical assessment.

How are Biliary Colic and Cholecystitis Diagnosed?

Diagnosis begins with a discussion of your symptoms, medical history and current medicines, followed by an examination of your abdomen. An ultrasound scan of the abdomen is usually the first and most useful test, as it is painless and highly accurate at identifying gallstones and signs of gallbladder inflammation. Blood tests are also used to check for markers of infection and inflammation, and to assess how well your liver is functioning. In some cases, a CT or MRI scan of the abdomen may be recommended to look more closely at the gallbladder and surrounding structures, particularly if the diagnosis is unclear or complications are suspected.

What if there’s no stone? Biliary Dyskinesia

Occasionally, someone experiences the same pattern of biliary-type pain as biliary colic, but an ultrasound and other imaging do not show any gallstones. This is known as biliary dyskinesia, or gallbladder dysfunction, where the gallbladder does not contract and empty bile normally even though no stone is present. It is considered only once gallstones and other structural causes have been ruled out.
Because biliary dyskinesia does not show up on a standard ultrasound, confirming it usually involves a specialised scan called a cholescintigraphy, or HIDA scan, which measures how well the gallbladder empties in response to a stimulating medicine given during the test. A reduced gallbladder emptying result on this scan, together with typical symptoms, supports the diagnosis. For people with confirmed biliary dyskinesia and significant symptoms, removal of the gallbladder can improve or resolve the pain, in a similar way to how it helps people with gallstone-related disease.

Treatment Options

Managing an Episode of Biliary Colic

A single episode of biliary colic often settles without hospital admission. Pain-relieving medication can help manage symptoms while the episode resolves, and temporarily avoiding fatty or heavy meals may reduce the likelihood of triggering another attack. Because biliary colic tends to recur and can progress to cholecystitis or other complications over time, ongoing episodes are usually a reason to see a gastroenterologist for further assessment and a longer-term management plan.

Treating Cholecystitis

Cholecystitis generally requires admission to hospital. Initial treatment focuses on resting the gallbladder and controlling infection and inflammation, and usually involves fasting, intravenous fluids, infection-fighting medication and pain-relief medication given through a drip. Once the acute episode is under control, surgical removal of the gallbladder, known as a cholecystectomy, is the standard treatment for most people, since it addresses the underlying cause and prevents future attacks.
It is worth understanding the different roles involved in your care. Cholecystectomy is a surgical operation and is carried out by a surgeon, most often using keyhole (laparoscopic) technique with a short hospital stay, though open surgery is occasionally needed. Your gastroenterologist’s role focuses on diagnosis, imaging and, where a stone has also moved into the bile duct, a procedure called ERCP to clear the duct. Your gastroenterologist and surgical team work together, along with your GP, to coordinate this care.

Potential Complications

Most people recover well from biliary colic and cholecystitis, particularly once the gallbladder is removed. However, if cholecystitis is left untreated, complications can develop, including infection spreading to the bile ducts, a collection of pus known as an abscess, or, rarely, a tear in the gallbladder wall. These complications can become serious quickly and often require urgent hospital treatment, which is why prompt assessment of a suspected cholecystitis episode is so important.

Can Gallbladder Attacks Be Prevented?

There is no guaranteed way to prevent gallstones or the attacks they cause, but some lifestyle factors may lower your risk. These include eating a diet that is high in fibre and low in saturated fat, maintaining a healthy body weight through gradual rather than rapid weight loss, and staying physically active. Patients recommended for and or seeking tailored dietary advice, can find a qualified dietitian through the Dietitians Australia Find a Dietitian directory.

When to Seek Urgent Care

See your doctor if you develop abdominal pain together with fever, nausea or vomiting. If the pain is so severe that you cannot find a comfortable position, this may indicate cholecystitis or another serious complication, and you should go to your nearest hospital emergency department without delay rather than waiting for a routine appointment.

When to See a Gastroenterologist

If you experience recurring episodes of upper abdominal pain, or you have been diagnosed with gallstones and are unsure what your symptoms mean, speak with your GP about a referral to Queensland Gastroenterology. Your GP can arrange this referral so our specialists can investigate your symptoms further, which may include additional imaging such as endoscopic ultrasound, and work alongside your GP and, where surgery is needed, your surgical team to guide you through the most appropriate next steps.

References

This information has been adapted from the following sources, as at 1/08/2026. It is intended for general patient education and does not replace individual medical advice from your GP or gastroenterologist.

Healthdirect Australia. Cholecystitis (gallbladder inflammation). Reviewed September 2024. Available at: https://www.healthdirect.gov.au/cholecystitis-gallbladder-inflammation

Gastroenterological Society of Australia (GESA). Gallstones [patient information factsheet]. Reviewed 2021 by Dr William Wang and Clin A/Prof Payal Saxena, Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, NSW.

Better Health Channel, Victorian Department of Health. Gallbladder – gallstones and surgery. Reviewed 14 August 2023. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gallbladder-gallstones-and-surgery

Behar J, Corazziari E, Guelrud M, Hogan W, Sherman S, Toouli J. Functional gallbladder and sphincter of Oddi disorders. 2006. Gastroenterology. 130(5):1498–1509.

Popover JL, Oulton ZW, Brown ZG, King NE, Sardzinski EE, Imam A, Al Masri M, Robles Y, Kannan U, Gaddis B, Toomey PG. 2025. Biliary Dyskinesia – Is It Real? JSLS. 29(1):e2024.00053.