Last reviewed: 23 Aug 2021
Last updated: 03 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • previous episode of biliary pain
  • right upper quadrant pain
  • positive Murphy sign
  • abdominal mass

Other diagnostic factors

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

Risk factors

  • gallstones
  • physical inactivity
  • low fiber intake
  • severe illness
  • trauma
  • severe burns
  • total parenteral nutrition (TPN)
  • diabetes
  • ceftriaxone
  • cyclosporine
  • hepatic arterial embolization
  • infections

Diagnostic investigations

1st investigations to order

  • CBC
  • C-reactive protein
  • LFTs
  • right upper quadrant ultrasound scan

Investigations to consider

  • cholescintigraphy (hepatobiliary iminodiacetic acid [HIDA] scan)
  • abdominal CT
  • abdominal MRI
  • abdominal x-ray

Treatment algorithm

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.

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