Last reviewed: 1 Nov 2024
Last updated: 14 Aug 2024
Summary
Definition
History and exam
Key diagnostic factors
- previous episode of biliary pain
- right upper quadrant pain
- positive Murphy sign
- abdominal mass
Full details
Other diagnostic factors
- right shoulder pain
- anorexia
- nausea
- fever
- vomiting
- jaundice
Full details
Risk factors
- gallstones
- physical inactivity
- low fiber intake
- severe illness
- trauma
- severe burns
- total parenteral nutrition (TPN)
- diabetes
- ceftriaxone
- cyclosporine
- hepatic arterial embolization
- infections
Full details
Diagnostic tests
1st tests to order
- CBC
- C-reactive protein
- LFTs
- right upper quadrant ultrasound scan
Full details
Tests to consider
- cholescintigraphy (hepatobiliary iminodiacetic acid [HIDA] scan)
- abdominal CT
- abdominal MRI
- abdominal x-ray
Full details
Treatment algorithm
ACUTE
mild (grade I): stable without signs of perforation/gangrene
moderate (grade II): stable with signs of perforation/gangrene
severe (grade III): suspected gangrene/perforation or evidence of organ dysfunction
Contributors
Authors
Charles Bellows, MD
Professor of Surgery
University of New Mexico
School of Medicine
Albuquerque
NM
Disclosures
CB is an author of one study referenced in this topic. CB declares that he has no other competing interests.
Peer reviewers
Satyajit Bhattacharya, LVO, MB, MS, MPhil, FRCS
Consultant Surgeon
HPB Surgery Unit
The Royal London Hospital
London
UK
Disclosures
SB declares that he has no competing interests.
Stefano Guandalini, MD
Professor of Pediatrics
Chief
Division of Gastroenterology, Hepatology, and Nutrition
University of Chicago Comer Children's Hospital
Chicago
IL
Disclosures
SG declares that he has no competing interests.
Differentials
- Acute cholangitis
- Chronic cholecystitis
- Peptic ulcer disease
More DifferentialsGuidelines
- ACR appropriateness criteria: right upper quadrant pain
- TG18 flowchart for the management of acute cholecystitis
More GuidelinesPatient information
Gallstones
More Patient informationVideos
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