Categories
Surgery

Biliary Colic

Last Updated on October 2, 2022

Introduction

When gallbladder neck is impacted by gallstones or when gallstones passing through the common bile duct, the gallstones may cause pain

Features

  • Right hypochondriac pain
  • No fever
  • No jaundice, no pape stool, no tea-colored urine
  • White cell count not raised

Differential Diagnosis

  • Acute coronary syndrome (ACS)
  • Acute cholecystitis / Ascending cholangitis
  • Peptic ulcer disease
  • Acute pancreatitis
  • Urinary tract infection (UTI)

Management in ED

Pain control

  • Analgesia e.g. IV Tramadol 50 mg stat & TDS / IM Voltaren 50 mg stat
  • Morphine, fentanyl are not recommended as these can cause bile duct spasm which worsens the symptom
  • Once pain well controlled, patient may be discharged

Referral

  • Refer case to General Surgical team

Discharge plan

  • USG HBS outpatient appointment
  • Referral letter to SOPD
  • Analgesia e.g. T Voltaren 50 mg TDS / PRN OR C Tramadol 50 mg TDS / PRN OR C Celebrex 200 mg OD OR T Paracetamol 1 g QID for 1 week
  • Advise to come back to ED stat if fever / worsening pain / jaundiced

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