Last reviewed:October 2019
Last updated:August  2019

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

Diagnostic investigations

1st investigations to order

  • CBC
  • serum LFTs
  • serum lipase and amylase
  • abdominal ultrasound
Full details

Investigations to consider

  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound scan (EUS)
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • abdominal CT scan
Full details

Treatment algorithm

Contributors

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.

Peer reviewersVIEW ALL

Assistant Professor

Director of Pancreatic Disorders

Section of Gastroenterology

Dartmouth-Hitchcock Medical Center

Lebanon

NH

Disclosures

TBG declares that he has no competing interests.

Professor of Hepatobiliary Surgery

Manchester Royal Infirmary

Manchester

UK

Disclosures

AS declares that he has no competing interests.

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.

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