Gallstones
Questionnaire/history:
Biliary colic?
- Pain lasting 30 minutes to 8 hours?
- Nausea?
- Vomiting?
Acute cholecystitis?
- Fever?
- Tenderness in right upper quadrant?
Obstructive jaundice?
- Charcot’s triad?
--- Fever (often with rigors)?
--- Jaundice?
--- Upper quadrant abdominal pain?
Gallstone pancreatitis?
- Constant epigastric pain radiating through to the back?
- Vomiting?
General symptoms?
- Indigestion?
- Intolerance to fatty food?
- Generalised abdominal discomfort?
Past medical history:
- Risk factors?
--- Obesity?
--- Diabetes?
--- Non-alcoholic fatty liver disease?
--- Higher levels of serum triglycerides?
--- Lower levels of high-density lipoprotein?
--- Increasing age?
--- Female gender?
--- Smoking?
--- Crohn’s disease
Current medication:
- Oral contraceptives?
- HRT?
Known drug allergies:
Examination:
Fever?
Tenderness in the right upper quadrant?
Jaundice?
Investigations:
Liver function test?
Abdominal ultrasound?
(Note: negative tests do not exclude the diagnosis)?
Management
Admission if:
Systematically unwell with a suspected complication of gallstone disease, such as acute cholecystitis, cholangitis, or pancreatitis
Referral to surgical outpatients:
All other people with suspected symptomatic gallstone disease
Advised:
Paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) for intermittent mild to moderate pain (eg diclofenac which can be given orally or rectally if nausea is a problem or parenteral (eg 75 mg IM with an option to repeat after 30 min. if necessary) for rapid relief of severe pain)
Opioid intramuscularly (for example morphine or pethidine) if diclofenac is not suitable or is not providing adequate pain relief
To avoid food or drinks that trigger symptoms until definitive surgical management
Resource(s):