Ver el código de «Symptomatic cholelithiasis»

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==Background==

*While a significant portion of the population have asymptomatic gallstones, symptomatic cholelithiasis refers to pain caused by intermittent obstruction of the cystic duct by a stone
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{{Gallbladder background}}
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{{Gallbladder disease types}}
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==Clinical Features==


===History===

*[[Special:MyLanguage/RUQ pain|RUQ pain]] or [[Special:MyLanguage/epigastric pain|epigastric pain]], often postprandial and constant, lasting 1-5hrs and then remits
**"Colic" can be a misnomer, as biliary colic is often described by patients as constant
**May radiate to the right upper back; radiation to the right shoulder increases likelihood, but is not sensitive
**Pain >5hr suggests other causes, including [[Special:MyLanguage/cholecystitis|cholecystitis]], [[Special:MyLanguage/cholangitis|cholangitis]], or [[Special:MyLanguage/pancreatitis|pancreatitis]]
*[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]]


===Physical Exam===

*Often benign; as compared to cholecystitis, usually negative Murphy's Sign
*May have mild RUQ or epigastric tenderness, or voluntary guarding due to anticipated tenderness
*Usually afebrile with normal vital signs, except for possibly tachycardia due to pain or dehydration


==Differential Diagnosis==

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{{DDX RUQ}}
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==Evaluation==

[[File:Ultrasonography of sludge and gallstones, annotated.jpg|thumb|Biliary sludge and gallstones. There is borderline thickening of the gallbladder wall.]]
[[File:StonesXray.png|thumb|Gallstones found incidentally on [[Special:MyLanguage/KUB|KUB]] (xrays are not sensitive).]]
[[File:LargeGstoneMark.png|thumb|Large gallstone as seen on CT.]]
*Labs
**CBC expected to be normal
**[[Special:MyLanguage/LFTs|LFTs]]
**Consider bilirubin, alkaline phosphatase, and GGT if common bile duct pathology is suspected
*[[Special:MyLanguage/RUQ Ultrasound|RUQ Ultrasound]] is the first-line study
**Will show echogenic stones with posterior acoustic shadowing, dependent on positioning
**No pericholecystic fluid, thickened gallbladder wall, or distended gallbladder to suggest cholecystitis
**Sensitivity 84%, Specificity 99%
*CT abdomen/pelvis can be considered if suspecting pathology in the biliary tree and distal CBD, or if other intra-abdominal pathology is suspected


==Management==

*IV/IM [[Special:MyLanguage/ketorolac|ketorolac]]
*[[Special:MyLanguage/morphine|morphine]] or [[Special:MyLanguage/hydromorphone|hydromorphone]]
**Despite the theoretical increase in sphincter of Oddi pressure, opioids are still indicated if pain is refractory to NSAIDs


==Disposition==

*Discharge
**Provide early follow-up with a general surgeon for elective cholecystectomy
**Counsel for low-fat diet and provide prescription for analgesics
*Consider admission for cholecystectomy if intractable abdominal pain or vomiting, large gallstones, porcelain gallbladder, or signs of peritonitis


==See Also==

*[[Special:MyLanguage/Gallbladder Disease (Main)|Gallbladder Disease (Main)]]
*[[Special:MyLanguage/Biliary ultrasound|Biliary ultrasound]]


==References==

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[[Category:GI]]
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