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Cholelithiasis, Emergency Medicine

Robert G. Buckley Reviewed 06/2017
 


Basics

Description

  • Symptoms arise when gallstones pass through the cystic or common bile ducts leading to impedance of normal bile flow and gallbladder spasm.

  • Biliary dyskinesia produces symptoms identi...

Diagnosis

Signs and Symptoms

History

  • Dull, aching epigastric or right upper quadrant (RUQ) pain:

    • Arising over 2–3 min, continuous (rather than colicky), and lasting from 30 min–6 hr before dissipating

    • May...

Treatment

Pre-Hospital

Initiate IV access for patients with nausea or vomiting. 

Initial Stabilization/Therapy

IV fluid bolus if vomiting or hypotensive 

Ed Treatment/Procedures

  • IV hydration with 0.9% NS i...

Follow-Up

Disposition

Admission Criteria

Admission and surgical or gastroenterologic consultation for evidence of: 
  • Acute cholecystitis

  • Acute cholangitis

  • Common duct obstruction

  • Gallstone pancreatitis

Discharge Criteria

Pearls and Pitfalls

  • Alternative causes of upper abdominal pain may be falsely attributed to incidental finding of gallstones.

  • An ultrasound is more sensitive and specific for cholelithiasis.

  • Radionuclid...

Additional Reading

  • Antevil  JL, Buckley  RG, Johnson  AS, et al. Treatment of suspected symptomatic cholelithiasis with glycopyrrolate: A prospective, randomized clinical trial. Ann Emerg Med.  2...

Codes

ICD9

  • 574.20 Calculus of gallbladder without mention of cholecystitis, without mention of obstruction

  • 574.21 Calculus of gallbladder without mention of cholecystitis, with obstruction

  • 574.90 Calculu...

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