Summary
Definition
History and exam
Key diagnostic factors
- right upper quadrant or epigastric pain (lasting >30 minutes)
Other diagnostic factors
- postprandial pain
- right upper quadrant or epigastric tenderness
- nausea
- jaundice
Risk factors
- increasing age
- female sex
- Hispanic and Native American ethnicity
- family history of gallstones
- gene mutations
- pregnancy/exogenous estrogen
- obesity, diabetes, and metabolic syndrome
- nonalcoholic liver disease
- prolonged fasting/rapid weight loss
- total parenteral nutrition (TPN)
- octreotide
- incretin-based drugs
- ceftriaxone
- terminal ileum disease or resection
- hemoglobinopathy
- low-fiber diet
- helicobacter pylori gallbladder infection
Diagnostic investigations
1st investigations to order
- CBC
- serum LFTs
- serum lipase or amylase
- abdominal ultrasound
Investigations to consider
- abdominal CT scan
- magnetic resonance cholangiopancreatography (MRCP)
- endoscopic ultrasound scan (EUS)
- endoscopic retrograde cholangiopancreatography (ERCP)
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 declares that he has no competing interests.
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 (Healthcare informatics)
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
- Peptic ulcer disease (PUD)
- Gallbladder cancer
- Gallbladder polyps
More DifferentialsGuidelines
- The role of endoscopy in the evaluation of suspected choledocholithiasis
- ACR appropriateness criteria: right upper quadrant pain
More GuidelinesPatient leaflets
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