Summary
Definition
History and exam
Key diagnostic factors
- right upper quadrant (RUQ) or epigastric pain (lasting >30 minutes)
Other diagnostic factors
- postprandial pain
- RUQ or epigastric tenderness
- nausea
- jaundice
Risk factors
- increasing age
- female sex
- Hispanic and American Indian ethnicity
- family history of gallstones
- gene mutations
- estrogen and progesterone
- obesity, diabetes, and metabolic syndrome
- nonalcoholic liver disease
- prolonged fasting/rapid weight loss
- total parenteral nutrition (TPN)
- octreotide
- glucagon-like peptide 1 (GLP-1) analogs
- ceftriaxone
- terminal ileum disease or resection
- hemoglobinopathy
- cirrhosis
- cystic fibrosis
- diet and lifestyle
- helicobacter pylori gallbladder infection
Diagnostic tests
1st tests to order
- abdominal ultrasound
- serum LFTs
- CBC
- serum lipase or amylase
Tests to consider
- magnetic resonance cholangiopancreatography (MRCP)
- endoscopic ultrasound scan (EUS)
- endoscopic retrograde cholangiopancreatography (ERCP)
- abdominal CT scan
Treatment algorithm
symptomatic cholelithiasis
choledocholithiasis with or without symptoms
asymptomatic cholelithiasis
Contributors
Authors
Eldon Shaffer, MD, FRCPC
Emeritus Professor of Medicine
Division of Gastroenterology
University of Calgary
Calgary
Canada
Disclosures
ES is an author of several references cited in this topic.
Acknowledgements
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
Timothy B. Gardner, MD
Assistant Professor
Director of Pancreatic Disorders
Section of Gastroenterology
Dartmouth-Hitchcock Medical Center
Lebanon
NH
Disclosures
TBG declares that he has no competing interests.
Ajith Siriwardena, MD, FRCS
Professor of Hepatobiliary Surgery
Manchester Royal Infirmary
Manchester
UK
Disclosures
AS declares that he has no competing interests.
Kurinchi Gurusamy, MBBS, MS, MRCS, MSc
Clinical Research Fellow
Hepatopancreatobiliary and Liver Transplant Surgery
University Department of Surgery
Royal Free Campus
UCL Medical School
London
UK
Disclosures
KG declares that he has no competing interests.
Differentials
- Acalculous cholecystitis
- Nonbiliary acute pancreatitis
- Peptic ulcer disease (PUD)
More DifferentialsGuidelines
- ACR appropriateness criteria: right upper quadrant pain
- 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
More GuidelinesPatient information
Gallstones
Gallstones: questions to ask your doctor
More Patient informationVideos
Practical suturing techniques: animated demonstrations
More videos- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer