Presentations

Question 1

How does biliary colic classically present?

Answer 1

Characterised by steady, severe (intensity >5 on a scale of 1 to 10) pain in the right upper quadrant of the abdomen lasting more than 15 to 30 minutes.
An attack of simple biliary colic commonly requires an analgesic but should resolve within 5 hours.

Question 2

How does cholecystitis classically present?

Answer 2

Biliary pain lasting more than 5 hours is accompanied by features of inflammation: fever, marked RUQ tenderness (Murphy’s sign), and leukocytosis.
Some patients progress to sepsis.
Occasionally, stones can perforate the gallbladder leading to intestinal obstruction (gallstone ileus).

Question 3

How does choledocholithiasis classically present?

Answer 3

When stones obstruct the bile ducts, biliary-type pain is accompanied by cholestasis which manifests as jaundice.
More sinister is acute cholangitis, characterised by Charcot’s triad of biliary pain, jaundice, and fever.
Acute cholangitis represents a medical emergency.

Question 4

How does acute pancreatitis classically present?

Answer 4

Epigastric pain radiating to the back results from bile duct stones obstructing the pancreatic ducts.
Inflammatory features include peritonitis.