Biliary Tract Disease (acute)

GALLSTONES (acute Biliary Colic)

Classic Symptoms:
  • RUQ abdominal pain
  • Radiates to right back or shoulder
  • Nausea / vomiting
  • RUQ tenderness
  • ? positive Murphy’s sign (palpate deep in RUQ as pt takes slow breaths; suddenly they freeze & gasp)
Key symptom:  Chronology!!!
  • Recurrent episodes of severe upper abdominal pain lasting <12 hours
  • Pain peaks over 1 hr, subsides similarly.
  • Often with associated nausea / vomiting

If symptomatic during presentation, LFTs may be elevated (esp. Alk Phos)

Dx by image:  Ultrasound preferred over CT

Send to ER:  Fever, jaundice


Much more serious:
  • Prolonged severe pain (>1 day) with positive Murphy’s
  • Fever, jaundice

Send to ER.

See posting Abdominal Pain – 1.