See also:
     Abdominal pain Ddx
     Biliary disease
Pathophysiology
     May be caused by undiagnosed hereditary spherocytosis
Hx
     Pain that is triggered by eating fatty food
Sx
     RUQ pain that may radiate under the scapula
     Nausea
     Vomiting
     Low grade fever
     Pain is usually colicky but steadily worsens until it becomes constant and unremitting
     Pain may worsen with deep inspiration or jarring of the patient if the parietal peritoneum is secondarily inflamed.
     Pain is not alleviated by milk or antacids (unlike in PUD)
     Peritoneal signs are possible
NOT Sx
     Shock and hypotension are not typical of uncomplicated cholecystitis (unless gangrene or gallbladder rupture has occurred).
Workup
     CBC
     AST/ALT/bilirubin/ALP
     US-abdomen
     HIDA scan (for cholecystitis or cholethiasis)
Workup (broader)
     H. pylori antibody testing (for PUD)
     Upper endoscopy (for PUD)
     Rectal exam and stool for occult blood (for perforated or bleeding ulcer)
Dx
     Positive murphy's sign
     US is informative.
     Endoscopic retrograde cholangiopancreatography (ERCP) is both diagnostic and therapeutic.
     May also diagnose via MRI.
Tx
     Patients with uncomplicated cholecystitis may benefit from early cholecystectomy
     Patients with severe or symptomatic cholecystitis, complicated cholecystitis (an immunosuppressed patient, possible abscess, or gangrenous cholecystitis) may require emergent surgery.

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.