Summary
Definition
History and exam
Key diagnostic factors
- right upper quadrant or epigastric pain (typically lasting >30 minutes)
- presence of risk factors
Other diagnostic factors
- postprandial pain
- right upper quadrant or epigastric tenderness
- nausea
- jaundice
Risk factors
- increasing age
- female sex
- obesity, diabetes, and metabolic syndrome
- family history of gallstones
- gene mutations
- pregnancy/exogenous oestrogen
- non-alcoholic liver disease
- prolonged fasting/rapid weight loss
- total parenteral nutrition (TPN)
- medication
- terminal ileum disease or resection
- haemoglobinopathy
- Hispanic and Native-American ethnicity
- low-fibre diet
- helicobacter pylori gallbladder infection
Diagnostic investigations
Investigations to consider
- magnetic resonance cholangiopancreatography (MRCP)
- endoscopic ultrasound scan (EUS)
- abdominal CT scan
Treatment algorithm
Contributors
Expert advisers
Emeritus Professor of Medicine
Division of Gastroenterology
University of Calgary
Calgary
Canada
Disclosures
ES declares that he has no competing interests.
Professor Eldon Shaffer would like to gratefully acknowledge Dr Vikesh K. Singh and Dr Anthony N. Kalloo, previous contributors to this topic.
Disclosures
VKS and ANK declare that they have no competing interests.
Peer reviewers
Consultant General and Hepato-Pancreato-Biliary Surgeon
Clinical Lead for Emergency General Surgery, Gastrointestinal Medicine, and Surgery CSU
Manchester Royal Infirmary
Manchester
Director of Scientific Programme
Association of Surgeons of Great Britain and Ireland
UK
Disclosures
CM declares that he has no competing interests.
Consultant in Emergency General Surgery
Service Director for Emergency Assessment Unit (Surgical)
Norfolk and Norwich University Hospitals
Norwich
UKĀ
Disclosures
LE declares that he has no competing interests.
Editors
Section Editor, BMJ Best Practice
Disclosures
CP declares that she has no competing interests.
Head of Editorial, BMJ Knowledge Centre
Disclosures
JH declares that she has no competing interests.
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
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