When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 15 Mar 2025
Last updated: 20 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • right upper quadrant (RUQ) or epigastric pain (lasting >30 minutes)

Other diagnostic factors

  • postprandial pain
  • RUQ or epigastric tenderness
  • nausea
  • jaundice

Risk factors

  • increasing age
  • female sex
  • Hispanic and American Indian ethnicity
  • family history of gallstones
  • gene mutations
  • elevated estrogen and progesterone levels
  • obesity, diabetes, and metabolic syndrome
  • nonalcoholic fatty liver disease
  • prolonged fasting/rapid weight loss
  • total parenteral nutrition (TPN)
  • use of octreotide
  • use of glucagon-like peptide-1 (GLP-1) receptor agonists
  • use of ceftriaxone
  • terminal ileum disease or resection
  • hemoglobinopathy
  • cirrhosis
  • cystic fibrosis
  • diet and lifestyle
  • helicobacter pylori gallbladder infection

Diagnostic tests

1st tests to order

  • abdominal ultrasound
  • serum liver function tests
  • CBC
  • serum lipase or amylase

Tests to consider

  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound scan (EUS)
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • abdominal CT scan

Treatment algorithm

Contributors

Expert advisers

Eldon Shaffer, MD, FRCPC

Emeritus Professor of Medicine

Division of Gastroenterology

University of Calgary

Calgary

Canada

Disclosures

ES is an author of several references cited in this topic.

Acknowledgements

Professor Eldon Shaffer would like to gratefully acknowledge Dr Vikesh K. Singh and Dr Anthony N. Kalloo, previous contributors to this topic.

Disclosures

VKS and ANK declare that they have no competing interests.

Peer reviewers

Timothy B. Gardner, MD

Assistant Professor

Director of Pancreatic Disorders

Section of Gastroenterology

Dartmouth-Hitchcock Medical Center

Lebanon

NH

Disclosures

TBG declares that he has no competing interests.

Ajith Siriwardena, MD, FRCS

Professor of Hepatobiliary Surgery

Manchester Royal Infirmary

Manchester

UK

Disclosures

AS declares that he has no competing interests.

Kurinchi Gurusamy, MBBS, MS, MRCS, MSc

Clinical Research Fellow

Hepatopancreatobiliary and Liver Transplant Surgery

University Department of Surgery

Royal Free Campus

UCL Medical School

London

UK

Disclosures

KG declares that he has no competing interests.

Use of this content is subject to our disclaimer