Case history
Case history
A 46-year-old obese woman presents with a 6-hour history of moderate steady pain in the right upper quadrant (RUQ) that radiates through to her back. This pain began after eating dinner, gradually increased, and has remained constant over the last few hours. She has experienced previous episodes of similar pain for which she did not seek medical advice. Her vital signs are normal. The pertinent findings on physical examination are tenderness to palpation in the RUQ without guarding or rebound..
Other presentations
Biliary colic is characterised by steady, severe pain (intensity >5 on a scale of 1-10) in the right upper quadrant (RUQ) of the abdomen lasting more than 15 to 30 minutes.[1] An attack of simple biliary colic commonly requires an analgesic but should resolve within 8 hours.[8]
Acute cholecystitis is biliary pain lasting more than 5 hours, accompanied by features of inflammation, including fever, marked RUQ tenderness (Murphy's sign), and leukocytosis.[1] Cholecystitis can lead to sepsis.[9] For detailed coverage, see Acute cholecystitis.
Choledocholithiasis is when stones move into the bile ducts and obstruct them. This causes biliary-type pain accompanied by cholestasis, which manifests as jaundice.
More sinister is acute cholangitis, which is a medical emergency, characterised by Charcot's triad of biliary pain, jaundice, and fever.[1] For detailed coverage see Acute cholangitis.
Acute pancreatitis can occur if a stone has passed distally to the ampulla and blocks the main bile duct.[1] Pancreatitis presents with epigastric pain radiating to the back, nausea and vomiting, and elevated pancreatic enzymes.[1] Inflammatory features include peritonitis. For detailed coverage, see Acute pancreatitis.
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