Bilary Colic SSOU Guideline
Definition
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)
unlikely - Awaiting ultrasound confi rmation
Exclusion Criteria
- Febrile (> 37.8C) or rigors
- Raised WBC > 12,000
- Other abdominal diagnoses not excluded
- Peritionism
- Major co-morbidities
Investigations
- FBE
- UEC
- GLucose
- LFT
- Lipase
- Consider ultrasound
Suggested Medications
Ensure hydration managed either with oral or IV fluid Drug Dose Frequency Route Morphine 2.5-10mg IV prn 2 hours Metaclopramide 10 mg 6/24 prn IV/IM/Oral Ondansetron 4-8mg 8-12 hourly PO/IV Bucopan 20mg 6/24 prn IV 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