History and exam
Key diagnostic factors
common
right upper quadrant (RUQ) or epigastric pain (lasting >30 minutes)
Typical biliary pain occurs in the RUQ or epigastric area, sometimes after the consumption of food. This constant pain typically increases in intensity and lasts for several hours (biliary colic).[1] Pain of short duration (<30 minutes) is not biliary colic, while that of long duration (over 5 hours) suggests cholecystitis or another major complication.[1] Pain may be accompanied by nausea and sometimes vomiting.[1]
Dyspepsia, heartburn, flatulence, and bloating are common, but these features are not characteristic for gallstone disease.[1][2]
Other diagnostic factors
common
postprandial pain
Onset of pain may be after a meal, often around 1 hour after eating, particularly at night time.[73]
uncommon
nausea
Nausea may be present but more often accompanies pain from acute cholecystitis.[1]
jaundice
Jaundice develops primarily in patients with choledocholithiasis, and is characteristic of cholangitis.[31][75] Jaundice is uncommon in simple acute cholecystitis, except for Mirizzi syndrome (a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder, causing compression or inflammation of the common bile duct or common hepatic duct, resulting in obstruction and jaundice).[31]
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