Symptomatic cholelithiasis

Clinical Features

History

• RUQ pain that is constant, lasts 1-5hr, and then remits
  • Pain >5hr suggests cholecystitis, cholangitis, or pancreatitis
• Usually does not occur during fasting

Physical Exam

• Often benign; as compared to cholecystitis, usually negative Murphy's Sign

Differential Diagnosis

RUQ Pain

• Gallbladder disease
  • Symptomatic cholelithiasis (biliary colic)
  • Choledocholithiasis
  • Acute cholecystitis
  • Ascending cholangitis
  • Acalculous cholecystitis
• Pancreatitis
• Acute hepatitis
• Pancreatitis
• GERD
• Appendicitis (retrocecal)
• Pyogenic liver abscess
• Bowel obstruction
• Cirrhosis
• Budd-Chiari syndrome
• GU
  • Pyelonephritis
  • Kidney stone
  • Fitz-Hugh-Curtis Syndrome
• Other
  • Hepatomegaly due to CHF
  • Peptic ulcer disease with or without perforation
  • Pneumonia
  • Herpes zoster
  • Myocardial ischemia
  • Pulmonary embolism
  • Abdominal aortic aneurysm

Diagnosis

Gallstones found incidentally on KUB (xrays are not sensitive).

• Labs
  • LFT, CBC normal
• RUQ Ultrasound
  • Sensitivity 84%, Specificity 99%

Treatment

• IV/IM ketorolac vs. morphine
  • Prescription for ibuprofen or narcotic

Disposition

• Outpatient management

See Also

• Gallbladder Disease (Main)

See Also

• Gallbladder Disease (Main)
• Ultrasound: Gallbladder