Last Updated on August 19, 2026
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
×
Pain may be radiating to the back, pain may last for few mins to few hours, then it subsides. Patient may have similar character of pain with different severity previously.
- 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
)×UTI
Abbreviation: UTI
Urinary tract infection
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💡Remember
If Urine FEME / Urine dipstick shows feature of UTI (leucocyte positive, nitrite positive), do renal punch to look for sign of pyelonephritis
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×Fentanyl
Fentanyl: https://www.myhouseman.my/fentanyl/
- 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