Dawaa Reference

emergency

Acute Cholecystitis (Emergency Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Acute Cholecystitis - StatPearls, updated 6 July 2025 - https://www.ncbi.nlm.nih.gov/books/NBK459171/ · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • Acute Cholecystitis - StatPearls, updated 6 July 2025 - https://www.ncbi.nlm.nih.gov/books/NBK459171/
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Worsening right upper abdominal pain with bloating, nausea, vomiting, and trouble tolerating greasy or spicy food develops gradually in the chronic form [abdominal distension · abdominal pain · nausea · right upper quadrant pain · vomiting]
  • Pain can radiate to the mid-back or right shoulder, and intermittent episodes may go on for years before diagnosis
  • The acute form has the same symptoms but more severe, and can be confused with a cardiac problem
  • Attacks often follow eating high-fat food

Signs — what you find (1)

  • Murphy's sign, the patient stops breathing in when the examiner presses on the right upper quadrant, is the classic finding [apnoea]

Tests (7)

  • CBC and metabolic panel can be normal in the chronic form but often show a raised white count and liver enzymes in acute or severe disease
  • A raised bilirubin raises concern for a stone blocking the common bile duct, though labs can stay normal even in advanced disease
  • Amylase and lipase are checked to rule out pancreatitis
  • CT often serves as the first scan in the ER, showing a distended, thick-walled gallbladder, fluid around it, dense stones, and surrounding inflammation
  • Ultrasound is the preferred imaging test, showing a gallbladder wall thicker than 3 mm, edema, fluid around the gallbladder, and stones
  • A HIDA scan can clarify the diagnosis when ultrasound or CT are inconclusive; failure of the gallbladder to fill with tracer confirms cystic duct blockage
  • Adding cholecystokinin during a HIDA scan can reveal acalculous cholecystitis when no stones are present, and an ejection fraction under 35% suggests biliary dyskinesia

If not this — what else fits (4)

  • Biliary colic, a bile duct stone, or cholangitis are the closest biliary-tract mimics
  • Pancreatitis, hepatitis, or gastritis can present with similar upper abdominal pain
  • A hiatal hernia or peptic ulcer disease should also be considered
  • Appendicitis, mesenteric ischemia, or a small bowel obstruction round out the differential

SourceStatPearls "Acute Cholecystitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)

1st line
Adult dose and duration

Same-day hospital referral. Right upper quadrant pain with nausea, vomiting and intolerance of fatty food, plus Murphy's sign - inspiratory arrest during palpation of the right upper quadrant. This is not biliary colic that has gone on longer: colic settles, cholecystitis does not, and it is accompanied by fever and systemic upset. Ultrasound is the imaging of choice but the referral does not wait for it. - Refer, with advice

Paediatric dose

Rare in children and usually acalculous or associated with haemolytic disease; refer the same day.

Dose source

No dose - referral pathway, no medicine given in primary care

Cautions
  • Untreated, StatPearls records gallbladder perforation as killing 30% of those it happens to.
  • Hospital management is intravenous fluids and broad-spectrum antibiotics covering gram-negative rods and anaerobes, with laparoscopic cholecystectomy done early, on that same admission. (Acute Cholecystitis - StatPearls - NCBI Bookshelf, NBK459171) None of that is a primary-care prescription.
  • Do not treat as biliary colic with an antispasmodic and analgesia at home once there is fever or a positive Murphy's sign.
  • Jaundice, rigors or confusion suggest ascending cholangitis - that is an emergency admission, not a next-day referral.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.