Biliary pain

Question 1

Causes

Answer 1

Usually due to obstructing stone or inspissated bile (biliary sludge).

Question 2

Typical site of pain

Answer 2

Question 3

Diagnosis

Answer 3

Abdominal US/DIDA or HIDA or helical CT scan

WCC and CRP: may be ↑

Question 4

Management

Answer 4

Gallstone dissolution or lithotripsy

Cholecystectomy (main procedure)

Question 5

Treatment of acute cholecystitis

Answer 5

• Rest in bed
• IV fluids
• Nil orally

Analgesics: morphine 2.5–5 mg IV (titrate to effect) or fentanyl 50–100 mcg IV statim then titrate to effect or Ketorolac

Antibiotics: amoxycillin IV or IM plus gentamycin IV (if sepsis) or cephalosporins IM or IV

Cholecystectomy