What is included in emergency department (ED) care of biliary colic or acute cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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The primary goal of emergency department care is stabilization of the patient and an expedient diagnosis.

Suspect gallbladder colic in patients with less than 4-6 hours of right upper quadrant pain that radiates to the back. Consider acute uncomplicated cholecystitis in patients with pain of longer duration and with or without low-grade fever. Severe cholecystitis can develop into sepsis or cholangitis, especially in patients with diabetes or elderly patients, in whom the diagnosis may be delayed.

After assessment of the patient's airway, breathing, and circulation (ABCs), perform the standard opening gambit of intravenous (IV) line placement, pulse oximetry measurement, oxygen administration, electrocardiography recording, and monitoring. Send for laboratory studies when the IV line is placed; include blood cultures if the patient is febrile.

Replace volume loss with normal saline, then maintenance fluids. Make patients nothing by mouth (NPO). Nasogastric suction may be needed in patients with persistent vomiting or abdominal distention.

In patients who are unstable or have severe pain, consider a bedside ultrasonographic study to exclude an abdominal aortic aneurysm and assist in the diagnosis of cholecystitis. Signs on ultrasonograms include the presence of gallstones, an ultrasonographic Murphy sign, gallbladder wall thickening, and pericholecystic fluid. Competent emergency physician-performed bedside ultrasonography for the detection of acute cholecystitis has been shown to have a negative predictive value (NPV) of 95%, which is not markedly different from radiologist-performed formal ultrasonography. [20]

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