# Acute Cholecystitis (Emergency Referral)

- Category: emergency
- Review status: reviewed (every claim checked against a document named on this page)
- 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 date: 2026-08

## Verified against

- 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

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
ACUTE CHOLECYSTITIS (EMERGENCY REFERRAL)
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
Review status: REVIEWED against 2 sources listed above  (2026-08)

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
  Source  StatPearls "Acute Cholecystitis" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    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
   Peds     Rare in children and usually acalculous or associated with haemolytic disease; refer the
            same day.
   Source   No dose - referral pathway, no medicine given in primary care
   Caution  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.
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