Biliary Colic

HISTORY:

‍AbdominalRUQEpigastricRight flankback pain for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍crampingsharp

Pattern: ‍constantintermittent

Episode duration: ‍ ‍secminhoursdaysweeksmonths

Worsening factors: ‍noneeatingfatty foods

Treatments tried: ‍none, ‍effectiveineffective

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍jaundice

‍changes in stools

‍changes in urine color

‍bloating

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍shortness of breath



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Biliary Colic ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍LFTs, ‍lipase, ‍bilirubin

- Abdominal ultrasound

- CT scan of abdomen

- HIDA scan

- MRCP

- ERCP

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Opioids

- ‍Ceftriaxone, ‍Metronidazole if cholecystitis suspected

- Low fat diet

- Increase fluid intake

- Avoidance of rapid weight loss

- Referral to general surgeon

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if pain worsens, fever develops, jaundice appears, or if new symptoms develop such as vomiting or changes in stool color

- Go to ER if severe abdominal pain, severe vomiting, or fever