A 55yo man has had severe pain in the right hypochondrium for 24h. The pain comes in waves
and is accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty but
has normal temp. What is the most appropriate next inv?
a. US Abdomen
b. ERCP
c. MRCP
d. Serum amylase
e. UGI endoscopy
answer: US abdomen
biliary colic, let's look for stones!
Pathogenesis
• gallstone transiently impacted in cystic duct, no infection
Clinical Features
• steady, severe dull pain in epigastrium or RUQ for minutes to hours, crescendo-decrescendo
pattern
• may present with chest pain
• N/V
• frequently occurs at night or after fatty meal, not after fasting
• can radiate to right shoulder or scapula
• patients often restless
• no peritoneal findings, no systemic signs
Investigations
• normal blood work: CBC, electrolytes, LFTs, bilirubin, amylase
• U/S shows cholelithiasis, may show stone in cystic duct
Treatment
• analgesia, rehydration during colic episode
• elective cholecystectomy (95% success)
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