Contributor: Jorge Chalit-Hernandez, OMS3
Typically presents with biliary colic
Right upper quadrant abdominal pain lasting more than 30 minutes and subsiding over several hours
Often associated with fatty meals but not always
Must rule out other causes of pain
Peptic ulcer disease - typically presents with epigastric pain
Pancreatitis - pain that radiates to the back or family history of pancreatitis
Laboratory workup
LFTs including ALT, AST, and alkaline phosphatase are within the reference range
Lipase and amylase within the reference range
Imaging workup
RUQ ultrasound is unremarkable
Upper endoscopy with ultrasound can help rule out peptic ulcer disease and small stones
HIDA scan may show a reduced gallbladder ejection fraction below 30-35% or it may be normal
Opiates may give false-positive results
Opiates can sometimes make biliary colic worse due to their contractile effect on the sphincter of Oddi
Some patients may benefit from surgical intervention i.e. cholecystectomy
Classic biliary-type pain (best predictor of response to cholecystectomy)
Pain for > 3 months duration
Positive HIDA scan
References
Alhayo S, Eslick GD, Cox MR. Cholescintigraphy may have a role in selecting patients with biliary dyskinesia for cholecystectomy: a systematic review. ANZ J Surg. 2020;90(9):1647-1652. doi:10.1111/ans.16003
Arshi J, Layfield LJ, Esebua M. Mast cell infiltration and activation in the gallbladder wall: Implications for the pathogenesis of functional gallbladder disorder in adult patients. Ann Diagn Pathol. 2021;54:151798. doi:10.1016/j.anndiagpath.2021.151798
Carr JA, Walls J, Bryan LJ, Snider DL. The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech. 2009;19(3):222-226. doi:10.1097/SLE.0b013e3181a74690
Joehl RJ, Koch KL, Nahrwold DL. Opioid drugs cause bile duct obstruction during hepatobiliary scans. Am J Surg. 1984;147(1):134-138. doi:10.1016/0002-9610(84)90047-3
Mahid SS, Jafri NS, Brangers BC, Minor KS, Hornung CA, Galandiuk S. Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. 2009;144(2):180-187. doi:10.1001/archsurg.2008.543
Summarized & Edited by Jorge Chalit, OMS3
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