Symptomatic cholelithiasis - Revision history

Ostermayer: Prepared the page for translation

2026-01-05T00:00:17Z

Prepared the page for translation

← Revisión anterior		Revisión del 00:00 5 ene 2026
Línea 1:		Línea 1:
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	==Background==		==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		*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}}		{{Gallbladder background}}
			<translate>
			</translate>
	{{Gallbladder disease types}}		{{Gallbladder disease types}}
			<translate>


	==Clinical Features==		==Clinical Features==


	===History===		===History===
	*[[RUQ pain]] or [[epigastric pain]], often postprandial and constant, lasting 1-5hrs and then remits
			*[[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		**"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		**May radiate to the right upper back; radiation to the right shoulder increases likelihood, but is not sensitive
	**Pain >5hr suggests other causes, including [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]		**Pain >5hr suggests other causes, including [[Special:MyLanguage/cholecystitis\|cholecystitis]], [[Special:MyLanguage/cholangitis\|cholangitis]], or [[Special:MyLanguage/pancreatitis\|pancreatitis]]
	*[[Nausea and vomiting]]		*[[Special:MyLanguage/Nausea and vomiting\|Nausea and vomiting]]


	===Physical Exam===		===Physical Exam===

	*Often benign; as compared to cholecystitis, usually negative Murphy's Sign		*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		*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		*Usually afebrile with normal vital signs, except for possibly tachycardia due to pain or dehydration


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX RUQ}}		{{DDX RUQ}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Ultrasonography of sludge and gallstones, annotated.jpg\|thumb\|Biliary sludge and gallstones. There is borderline thickening of the gallbladder wall.]]		[[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 [[KUB]] (xrays are not sensitive).]]		[[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.]]		[[File:LargeGstoneMark.png\|thumb\|Large gallstone as seen on CT.]]
	*Labs		*Labs
	**CBC expected to be normal		**CBC expected to be normal
	**[[LFTs]]		**[[Special:MyLanguage/LFTs\|LFTs]]
	**Consider bilirubin, alkaline phosphatase, and GGT if common bile duct pathology is suspected		**Consider bilirubin, alkaline phosphatase, and GGT if common bile duct pathology is suspected
	*[[RUQ Ultrasound]] is the first-line study		*[[Special:MyLanguage/RUQ Ultrasound\|RUQ Ultrasound]] is the first-line study
	**Will show echogenic stones with posterior acoustic shadowing, dependent on positioning		**Will show echogenic stones with posterior acoustic shadowing, dependent on positioning
	**No pericholecystic fluid, thickened gallbladder wall, or distended gallbladder to suggest cholecystitis		**No pericholecystic fluid, thickened gallbladder wall, or distended gallbladder to suggest cholecystitis
	**Sensitivity 84%, Specificity 99%		**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		*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==		==Management==
	*IV/IM [[ketorolac]]
	*[[morphine]] or [[hydromorphone]]		*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		**Despite the theoretical increase in sphincter of Oddi pressure, opioids are still indicated if pain is refractory to NSAIDs


	==Disposition==		==Disposition==

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


	==See Also==		==See Also==
	*[[Gallbladder Disease (Main)]]
	*[[Biliary ultrasound]]		*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]
			*[[Special:MyLanguage/Biliary ultrasound\|Biliary ultrasound]]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: /* Evaluation */

2024-08-09T03:14:14Z

Evaluation

← Revisión anterior		Revisión del 03:14 9 ago 2024
Línea 21:		Línea 21:

	==Evaluation==		==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 [[KUB]] (xrays are not sensitive).]]		[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]
	[[File:LargeGstoneMark.png\|thumb\|Large gallstone as seen on CT.]]		[[File:LargeGstoneMark.png\|thumb\|Large gallstone as seen on CT.]]

Rossdonaldson1: /* Evaluation */

2024-08-09T03:12:53Z

Evaluation

← Revisión anterior		Revisión del 03:12 9 ago 2024
Línea 22:		Línea 22:
	==Evaluation==		==Evaluation==
	[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]		[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]
			[[File:LargeGstoneMark.png\|thumb\|Large gallstone as seen on CT.]]
	*Labs		*Labs
	**CBC expected to be normal		**CBC expected to be normal

Patricklin at 00:25, 26 July 2024

2024-07-26T00:25:53Z

← Revisión anterior		Revisión del 00:25 26 jul 2024
Línea 1:		Línea 1:
	==Background==		==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
	{{Gallbladder background}}		{{Gallbladder background}}
	{{Gallbladder disease types}}		{{Gallbladder disease types}}
Línea 5:		Línea 6:
	==Clinical Features==		==Clinical Features==
	===History===		===History===
	*[[RUQ pain]] ~~that is~~ constant, ~~lasts~~ 1-~~5hr,~~ and then remits		*[[RUQ pain]] or [[epigastric pain]], often postprandial and constant, lasting 1-5hrs and then remits
	**Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]		**"Colic" can be a misnomer, as biliary colic is often described by patients as constant
	*~~Usually does not occur during fasting~~		**May radiate to the right upper back; radiation to the right shoulder increases likelihood, but is not sensitive
	*Radiation to the right shoulder increases likelihood, but is not sensitive		**Pain >5hr suggests other causes, including [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]
			*[[Nausea and vomiting]]

	===Physical Exam===		===Physical Exam===
	*Often benign; as compared to cholecystitis, usually negative Murphy's Sign		*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==		==Differential Diagnosis==
Línea 19:		Línea 23:
	[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]		[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]
	*Labs		*Labs
	**[[LFTs]], ~~CBC normal~~		**CBC expected to be normal
	*[[RUQ Ultrasound]]		**[[LFTs]]
			**Consider bilirubin, alkaline phosphatase, and GGT if common bile duct pathology is suspected
			*[[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%		**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==		==Management==
	*IV/IM [[ketorolac~~]] vs. [[morphine~~]]		*IV/IM [[ketorolac]]
	**Prescription for [[~~ibuprofen~~]] or [[~~opioid~~]]		*[[morphine]] or [[hydromorphone]]
			**Despite the theoretical increase in sphincter of Oddi pressure, opioids are still indicated if pain is refractory to NSAIDs

	==Disposition==		==Disposition==
	*Discharge		*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==		==See Also==

ClaireLewis at 04:16, 30 September 2019

2019-09-30T04:16:59Z

← Revisión anterior		Revisión del 04:16 30 sep 2019
Línea 5:		Línea 5:
	==Clinical Features==		==Clinical Features==
	===History===		===History===
	*RUQ pain that is constant, lasts 1-5hr, and then remits		*[[RUQ pain]] that is constant, lasts 1-5hr, and then remits
	**Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]		**Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]
	*Usually does not occur during fasting		*Usually does not occur during fasting
Línea 19:		Línea 19:
	[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]		[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]
	*Labs		*Labs
	**~~LFT~~, CBC normal		**[[LFTs]], CBC normal
	*RUQ Ultrasound		*[[RUQ Ultrasound]]
	**Sensitivity 84%, Specificity 99%		**Sensitivity 84%, Specificity 99%

Kxl328: /* History */

2018-10-02T03:06:02Z

History

← Revisión anterior		Revisión del 03:06 2 oct 2018
Línea 8:		Línea 8:
	**Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]		**Pain >5hr suggests [[cholecystitis]], [[cholangitis]], or [[pancreatitis]]
	*Usually does not occur during fasting		*Usually does not occur during fasting
			*Radiation to the right shoulder increases likelihood, but is not sensitive

	===Physical Exam===		===Physical Exam===

Mholtz at 06:38, 13 July 2017

2017-07-13T06:38:45Z

← Revisión anterior		Revisión del 06:38 13 jul 2017
Línea 27:		Línea 27:

	==Disposition==		==Disposition==
	*~~Outpatient management~~		*Discharge

	==See Also==		==See Also==
	*[[Gallbladder Disease (Main)]]		*[[Gallbladder Disease (Main)]]
			*[[Biliary ultrasound]]

	==References==		==References==
			<references/>
	~~==See Also==~~
	*[[Gallbladder Disease (Main)]]
	*[[Biliary ultrasound]]

	[[Category:GI]]		[[Category:GI]]

Rossdonaldson1: /* Background */

2017-05-17T04:27:53Z

Background

← Revisión anterior		Revisión del 04:27 17 may 2017
Línea 1:		Línea 1:
	==Background==		==Background==
	{{Gallbladder background}}		{{Gallbladder background}}
			{{Gallbladder disease types}}

	==Clinical Features==		==Clinical Features==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T15:54:44Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 15:54 25 jul 2016
Línea 14:		Línea 14:
	{{DDX RUQ}}		{{DDX RUQ}}

	==~~Diagnosis~~==		==Evaluation==
	[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]		[[File:StonesXray.png\|thumb\|Gallstones found incidentally on [[KUB]] (xrays are not sensitive).]]
	*Labs		*Labs

ClaireLewis: /* Management */

2016-07-14T00:41:22Z

Management

← Revisión anterior		Revisión del 00:41 14 jul 2016
Línea 23:		Línea 23:
	==Management==		==Management==
	*IV/IM [[ketorolac]] vs. [[morphine]]		*IV/IM [[ketorolac]] vs. [[morphine]]
	**Prescription for [[ibuprofen]] or ~~narcotic~~		**Prescription for [[ibuprofen]] or [[opioid]]

	==Disposition==		==Disposition==