• Bilary Colic SSOU Guideline


    Pain in the right upper quadrant (RUQ) or epigastrium due to known or suspected gallstones in an afebrile, otherwise well patient. 

    If Cholecystitis is strongly suspected (fever, raised inflammatory marker, surgical signs or proonged duration surgical admission is likely to be preferred. 

    Note that Bilary Colic is one of the most likely cases to "fail" SSOU. Have a low threshold for seeking general surgical input early, even if you arrange for the patients to be seen in SSOU.

    Admission Criteria

    • Working diagnosis biliary colic responding well to analgesia<
    • Other abdominal diagnosis (eg AAA, pancreatitis)
    • Awaiting ultrasound confi rmation


    Exclusion Criteria

    • Febrile (> 37.8C) or rigors
    • Raised WBC > 12,000
    • Other abdominal diagnoses not excluded
    • Peritionism
    • Major co-morbidities



    • FBE
    • UEC
    • GLucose
    • LFT
    • Lipase
    • Consider ultrasound


    Suggested Medications

    Ensure hydration managed either with oral or IV fluid
    Morphine2.5-10mg IVprn2 hours
    Metaclopramide10 mg6/24 prnIV/IM/Oral
    Ondansetron4-8mg8-12 hourlyPO/IV
    Bucopan20mg6/24 prnIV


    Specific Observations 

    Report vomiting, abdominal pain or fever

    Specific Management Issues

    Surgical consultation if:

    • Raised WCC
    • Raised Lipase
    • Abdmormal LFT
    • Symptoms not settling
    • Ultrasound evidence of cholecystitis
    • Fever devleops


    Discharge Criteria

    • Pain free
    • Tolerates oral intake
    • General surgical OPD, private rooms or GP follow up arranged
    • Ultrasound completed or arranged
    • Suitable home situation


    Hospital Admission Criteria

    • Fever
    • Pain ongoing or recurs with food
    • Inability to take oral medication
    • Jaundice
    • Clinical signs of cholecystitis develop
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