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