Last reviewed: 7 Jan 2023
Last updated: 29 Dec 2022



History and exam

Key diagnostic factors

  • pain in the upper right quadrant
  • tenderness in the right upper quadrant
  • signs and symptoms of inflammation
  • palpable mass
  • presence of risk factors

Other diagnostic factors

  • fever/chills
  • nausea
  • right shoulder pain
  • anorexia
  • vomiting
  • jaundice

Risk factors

  • gallstones
  • physical inactivity
  • low fibre intake
  • severe illness
  • trauma
  • severe burns
  • total parenteral nutrition (TPN)
  • diabetes
  • ceftriaxone
  • ciclosporin
  • hepatic arterial embolisation
  • infections

Diagnostic investigations

1st investigations to order

  • CT or MRI of the abdomen
  • abdominal ultrasound
  • FBC
  • CRP
  • bilirubin
  • LFTs
  • serum lipase or amylase
  • blood cultures and/or bile cultures

Investigations to consider

  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound (EUS)

Treatment algorithmPage Error | BMJ Best Practice

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