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Biliary Colic and Cholecystitis Concern
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Biliary Colic and Cholecystitis Concern
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting symptoms
Symptom profile
▶
Right upper quadrant pain
Epigastric pain
Postprandial pain
Pain after fatty meals
Nausea
Vomiting
Anorexia
Subjective fever
Jaundice
Dark urine
Pale stools
Pruritus
Prior similar episodes
Baseline functional status change
OPQRST
OPQRST framework
▶
Onset
▶
Time of onset
Sudden onset
Gradual onset
First episode
Recurrent episodes
Provocation and palliation
▶
Triggered by meals
Triggered by fatty foods
Worse with movement
Worse with deep inspiration
Relief with fasting
Relief with analgesics
No relief with antacids
Quality
▶
Colicky
Constant
Pressure
Burning
Region and radiation
▶
Right upper quadrant
Epigastrium
Radiation to right scapula
Radiation to back
Radiation to chest
Severity
▶
Peak severity rating
Functional limitation
Timing
▶
Duration less than 6 hours
Duration more than 6 hours
Intermittent waves
Progressive worsening
Nocturnal episodes
Context and triggers
Exposures and recent events
▶
Recent large fatty meal
Rapid weight loss
Pregnancy or postpartum state
Recent travel
Sick contacts
Recent antibiotic exposure
Recent hospitalization
Alarm Features
Immediate escalation triggers
High risk features
▶
Hemodynamic instability
▶
Hypotension
Shock physiology
Altered mental status
▶
Confusion
Lethargy
Sepsis features
▶
Fever with rigors
Tachycardia with toxicity
Hypothermia
Peritonitis
▶
Rebound tenderness
Guarding
Suspected ascending cholangitis
▶
Fever
Jaundice
Right upper quadrant pain
Hypotension
Altered mental status
Suspected gallbladder perforation
▶
Diffuse abdominal pain
Peritoneal signs
Suspected pancreatitis with organ dysfunction
▶
Persistent hypotension
Hypoxemia
Suspicion of myocardial ischemia mimic
▶
Exertional chest discomfort
Diaphoresis
Vital sign danger thresholds
Physiologic danger
▶
Systolic blood pressure less than 90 mmHg
Heart rate greater than 120 per minute
Respiratory rate greater than 24 per minute
Oxygen saturation less than 92 percent on room air
Temperature 38.5 C or higher
Temperature less than 36 C
Medications
Current and recent agents
Medication reconciliation
▶
Anticoagulants
▶
Warfarin
Direct oral anticoagulants
Antiplatelets
▶
Aspirin
P2Y12 inhibitors
Diabetes therapies
▶
GLP 1 receptor agonists
SGLT2 inhibitors
Opioids
▶
Baseline opioid use
Recent dose escalation
NSAIDs
▶
Recent use
Contraindication history
Antibiotics
▶
Recent courses
Allergy history
Hormonal therapy
▶
Estrogen exposure
Pregnancy related medications
Supplements and herbals
▶
Weight loss supplements
Hepatotoxic supplements
Medication interactions and contraindications
Therapy limitations
▶
QT prolonging medications
▶
Macrolides
Fluoroquinolones
Renal impairment considerations
▶
NSAID avoidance
Dose adjustment prompts
Hepatic dysfunction considerations
▶
Acetaminophen daily maximum reduction
Sedative sensitivity
Diet
Recent intake patterns
Dietary exposures
▶
High fat meals
Recent fasting
Rapid weight loss dieting
Low fiber intake
Dehydration pattern
Poor oral intake
Alcohol exposure
Caffeine and energy drinks
Review of Systems
Gastrointestinal and hepatobiliary
ROS cluster
▶
Nausea
Vomiting
Bloating
Diarrhea
Constipation
Hematemesis
Melena
Hematochezia
Dyspepsia
Jaundice
Pruritus
Dark urine
Pale stools
Cardiopulmonary and systemic
ROS cluster
▶
Chest pain
Dyspnea
Palpitations
Syncope
Fever
Chills
Weight loss
Night sweats
Collateral History and Family History
Family and collateral
Collateral and family risks
▶
Collateral source reliability
Family history gallstones
Family history hemolytic disorders
Family history early cardiovascular disease
Household sick contacts
Social support reliability for discharge
Risk Factors
Patient specific risks for gallstone disease and complications
Risk profile
▶
Female sex
Age older than 40
Pregnancy
Postpartum state
Obesity
Rapid weight loss
Diabetes mellitus (E11.9)
Hemolytic disease
▶
Sickle cell disease (D57.1)
Hereditary spherocytosis (D58.0)
Cirrhosis (K74.60)
Total parenteral nutrition exposure
Prior biliary colic
Prior gallstone pancreatitis (K85.1)
Prior choledocholithiasis (K80.50)
Immunocompromised state
Older adult frailty
Exposure and procedural risks
Additional risks
▶
Recent ERCP
Recent abdominal surgery
Recent trauma
Travel related infection risk
Foodborne illness exposure
Differential Diagnosis
Life threatening
High risk differentials
▶
Ascending cholangitis (K83.09)
▶
Fever with jaundice
Hypotension
Altered mental status
Gallstone pancreatitis (K85.1)
▶
Epigastric pain radiating to back
Lipase elevation
Organ dysfunction
Perforated viscus (K63.1)
▶
Sudden severe pain
Peritonitis
Abdominal aortic aneurysm rupture (I71.3)
▶
Back pain
Hypotension
Pulsatile mass
Acute coronary syndrome (I21.9)
▶
Epigastric pain mimic
Diaphoresis
Exertional component
Mesenteric ischemia (K55.9)
▶
Pain out of proportion
Lactate elevation
Hepatic abscess (K75.0)
▶
Fever
Right upper quadrant tenderness
Sepsis of unclear source (A41.9)
▶
Hypotension
Altered mental status
Common
Common causes
▶
Biliary colic (K80.20)
▶
Postprandial episodes
Duration less than 6 hours
Afebrile
Acute cholecystitis (K81.0)
▶
Persistent pain more than 6 hours
Fever
Leukocytosis
Murphy sign
Choledocholithiasis (K80.50)
▶
Jaundice
Cholestatic liver enzyme pattern
Acute hepatitis (K75.9)
▶
Marked transaminase elevation
Exposure risks
Gastritis or peptic ulcer disease (K29.70) (K27.9)
▶
NSAID exposure
Melena
GERD (K21.9)
▶
Heartburn
Response to antacids
Less common and mimics
Other causes
▶
Acalculous cholecystitis (K81.0)
▶
Critical illness
Immunocompromised state
Fitz Hugh Curtis syndrome (K65.9)
▶
Pelvic inflammatory disease symptoms
Right upper quadrant pain
Right lower lobe pneumonia (J18.9)
▶
Cough
Pleuritic features
Renal colic (N20.0)
▶
Flank pain
Hematuria
Appendicitis (K35.80)
▶
Migratory pain
Right lower quadrant tenderness
Herpes zoster (B02.9)
▶
Dermatomal pain
Rash evolution
Past Medical History
Relevant history and procedures
Key background
▶
Known cholelithiasis
▶
Prior imaging results
Prior surgical consultation
Prior cholecystitis
▶
Complications
Antibiotic history
Prior pancreatitis
▶
Etiology
Severity
Prior ERCP
▶
Sphincterotomy
Stents
Prior abdominal surgeries
▶
Gastric bypass
Hepatobiliary surgery
Chronic liver disease
▶
Cirrhosis
Portal hypertension
Cardiac disease
▶
Coronary artery disease (I25.10)
Heart failure (I50.9)
Pregnancy status
▶
Gestational age
Obstetric complications
Physical Exam
General and vitals
General assessment
▶
Ill appearance
Toxic appearance
Diaphoresis
Hydration status
Vital sign pattern
▶
Fever
Tachycardia
Hypotension
Abdominal and hepatobiliary
Abdominal exam cluster
▶
Right upper quadrant tenderness
Epigastric tenderness
Murphy sign
Guarding
Rebound tenderness
Distension
Hepatomegaly
Palpable gallbladder
Bowel sounds abnormality
Skin cardiopulmonary and neuro
Focused exam cluster
▶
Scleral icterus
Jaundice
Excoriations from pruritus
Chest exam
▶
Right lower lobe crackles
Pleural findings
Cardiovascular exam
▶
New murmur
Poor perfusion
Neurologic exam
▶
Confusion
Asterixis
Lab Studies
Core laboratory evaluation
Baseline labs for biliary pathology
▶
CBC
▶
Leukocytosis support for cholecystitis
Hemolysis clues if pigment stones suspected
Electrolytes and renal function
▶
Dehydration assessment
Renal dosing prompts
Liver enzymes and bilirubin
▶
AST and ALT
Alkaline phosphatase
GGT
Total bilirubin
Direct bilirubin
Lipase
▶
Pancreatitis support
Mild elevation nonspecific
Lactate
▶
Sepsis physiology
Mesenteric ischemia concern
CRP
▶
Inflammatory severity support
Trend utility
Blood cultures
▶
Fever with suspected cholangitis
Before antibiotics when feasible
Pregnancy and metabolic modifiers
Special population labs
▶
Pregnancy test when applicable
▶
Positive result changes imaging selection
Obstetric consultation triggers
Glucose and ketones
▶
DKA mimic assessment
SGLT2 inhibitor euglycemic risk prompt
Imaging
Scoring Systems
Severity and risk tools
▶
Tokyo Guidelines acute cholecystitis severity
▶
Grade I mild
Grade II moderate
Grade III severe with organ dysfunction
ASGE risk stratification for choledocholithiasis
▶
High probability features
Intermediate probability features
Low probability features
Limitations
▶
Local protocol dependent operational definitions
Does not replace clinical judgment in shock
MRI
MRI and MRCP use cases
▶
MRCP for suspected choledocholithiasis
▶
Cholestatic lab pattern
Ductal dilation on ultrasound
Pregnancy preferred cross sectional imaging when available
▶
Avoid gadolinium unless essential
Local protocol dependent
Interpretation pearls
▶
Common bile duct stone visualization
Stricture and malignancy differentiation prompts
CT
CT abdomen pelvis role
▶
Complications suspected
▶
Perforation
Emphysematous cholecystitis
Abscess
Alternate diagnosis concern
▶
Appendicitis mimic
Bowel obstruction
Contrast cautions
▶
Renal dysfunction risk
Contrast allergy history
Radiation cautions
▶
Pregnancy avoidance when possible
Shared decision making prompts
Ultrasound
Right upper quadrant ultrasound first line
▶
Key findings supporting cholecystitis
▶
Gallstones
Gallbladder wall thickening
Pericholecystic fluid
Sonographic Murphy sign
Key findings supporting biliary obstruction
▶
Common bile duct dilation
Intrahepatic duct dilation
POCUS applications
▶
Gallstones detection
Gallbladder wall measurement
Pitfalls
▶
Limited windows with obesity
Early cholecystitis may have subtle findings
Small common bile duct stones may be missed
Special Tests
Functional and adjunct diagnostics
Additional tests when ultrasound nondiagnostic
▶
HIDA scan
▶
Nonvisualization consistent with acute cholecystitis
Delayed filling supportive of chronic cholecystitis
Endoscopic ultrasound
▶
Intermediate risk choledocholithiasis
Small duct stones detection
ERCP diagnostic and therapeutic
▶
High probability choledocholithiasis
Ascending cholangitis urgent decompression
Bedside maneuvers and reassessment
Serial bedside reassessment
▶
Pain trajectory after analgesia
Evolving peritoneal signs
Worsening jaundice or mental status change
ECG
When epigastric pain may be cardiac
ECG indications
▶
Epigastric pain with diaphoresis
Chest radiation
Older age
Diabetes mellitus
Hypotension
Abnormal vitals without clear abdominal source
Serial ECG logic
▶
Persistent symptoms with initial nondiagnostic ECG
Troponin pathway local protocol dependent
Assessment
Working diagnoses and key distinctions
Biliary colic (K80.20)
▶
Pain episodes less than 6 hours
Afebrile
Minimal tenderness between episodes
Normal or near normal inflammatory markers
Acute cholecystitis (K81.0)
▶
Persistent right upper quadrant pain more than 6 hours
Fever or leukocytosis
Murphy sign or localized peritonism
Ultrasound inflammatory features
Choledocholithiasis (K80.50)
▶
Jaundice
Cholestatic lab pattern
Ductal dilation
Ascending cholangitis (K83.09)
▶
Systemic toxicity
Fever with jaundice
Hypotension or altered mental status
Complications to rule out
Complication screen
▶
Gallstone pancreatitis (K85.1)
Gallbladder perforation
Emphysematous cholecystitis
Hepatic abscess
Sepsis
Alternate life threat mimics
Plan
First 5 minutes and stabilization
Immediate workflow
▶
Triage to monitored setting if instability
▶
Continuous pulse oximetry
Cardiac monitoring if systemic toxicity
IV access
▶
Two large bore IV lines if hypotension or sepsis concern
Single IV line if stable
Fluids
▶
If hypotension then isotonic crystalloid bolus 500 mL to 1000 mL
Reassess after each bolus for overload risk
Analgesia initiation
▶
Ketorolac IV 15 mg
Avoid ketorolac if renal impairment or GI bleed risk
Hydromorphone IV 0.2 mg to 0.5 mg
Repeat every 10 to 15 minutes to effect with monitoring
Antiemetic
▶
Ondansetron IV 4 mg
Repeat once if persistent
Antibiotics only when infection suspected
▶
Early antibiotics if cholecystitis with systemic features
Immediate antibiotics if cholangitis suspected
Diagnostic sequencing
Workup pathway
▶
RUQ ultrasound first line
Labs aligned to suspected complications
▶
LFTs and bilirubin for obstruction
Lipase for pancreatitis
Lactate for sepsis physiology
If cholangitis suspected then urgent biliary decompression pathway
▶
GI or surgery consult
ERCP access local protocol dependent
Antibiotics and source control
Antimicrobial therapy for acute cholecystitis or cholangitis
▶
Community acquired without severe sepsis
▶
Ceftriaxone IV 1 g
Metronidazole IV 500 mg
Severe sepsis or healthcare associated risk
▶
Piperacillin tazobactam IV 4.5 g
Dose interval local protocol dependent
Beta lactam allergy alternatives
▶
Ciprofloxacin IV 400 mg
Metronidazole IV 500 mg
Pregnancy considerations
▶
Avoid fluoroquinolones when possible
Ceftriaxone plus metronidazole generally acceptable local protocol dependent
Source control timing
▶
Early surgery consultation for cholecystitis
If unfit for surgery then percutaneous cholecystostomy pathway local protocol dependent
Urgent ERCP for cholangitis
Symptom control and supportive care
Supportive measures
▶
NPO until surgical plan clarified
Maintenance IV fluids if ongoing vomiting
Acetaminophen PO 1000 mg
Maximum daily dose reduction in liver disease
Avoid morphine if concern for sphincter of Oddi spasm is clinically relevant local practice dependent
Reassessment loop
Reassessment schedule
▶
Repeat vitals every 30 to 60 minutes if unstable
Repeat abdominal exam after analgesia
Escalate if new peritoneal signs
Escalate if rising bilirubin with toxicity
Escalate if worsening hypotension despite fluids
Disposition
Admission and procedural pathways
Level of care decision
▶
ICU criteria
▶
Persistent hypotension after fluids
Vasopressor requirement
Altered mental status from sepsis
Lactate persistently elevated with shock physiology
Inpatient admission criteria
▶
Acute cholecystitis with systemic signs
Suspected choledocholithiasis requiring MRCP or ERCP
Gallstone pancreatitis
Uncontrolled pain or vomiting
Inability to tolerate oral intake
Significant comorbidity or frailty
Observation pathway criteria
▶
Equivocal imaging with persistent symptoms
Need for serial exams and repeat labs
Discharge criteria
▶
Pain controlled on oral medications
Tolerating oral fluids
No fever
No jaundice
Reassuring labs and imaging
Reliable follow up within 48 to 72 hours
Follow up timing
Copy
Follow up plan
▶
Surgery referral for symptomatic cholelithiasis
Timing within 1 to 2 weeks if recurrent biliary colic
Earlier follow up if frequent episodes or complications risk
Primary care follow up for risk factor modification
Discharge Instructions
Copy discharge instructions
Copy
Discharge text
▶
Diagnosis likely biliary colic from gallstones
Return now for fever
Return now for worsening or constant pain lasting more than 6 hours
Return now for yellowing of eyes or skin
Return now for dark urine or pale stools
Return now for persistent vomiting or inability to keep fluids down
Return now for fainting or severe weakness
Diet for next 48 hours
▶
Low fat foods
Small frequent meals
Medications
▶
Acetaminophen as directed on label
Avoid NSAIDs if kidney disease or stomach bleeding history
Avoid alcohol while taking pain medicines
Follow up
▶
Surgical consultation for gallbladder removal
Primary care follow up within 1 week
Safety
▶
Do not drive after opioid pain medication
Seek care sooner if symptoms are changing quickly
References
Guidelines and evidence
Evidence sources
▶
Tokyo Guidelines for management of acute cholecystitis and acute cholangitis 2018
World Society of Emergency Surgery guidelines for acute calculous cholecystitis 2020
American Society for Gastrointestinal Endoscopy guideline on choledocholithiasis risk stratification and ERCP indications 2019
American College of Radiology Appropriateness Criteria right upper quadrant pain 2023
Surviving Sepsis Campaign guidelines 2021
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Biliary Colic and Cholecystitis Concern