Right upper quadrant pain caused by obstruction of the cystic duct.

Demographics: 1-3% of those with stones

Risk Factors

“Female, fat, 40, fertile, fair”, increased age, family history, rapid weight change, fatty meal common trigger

Pathophysiology

Gall bladder contracting in response to stimulus → gall stone into cystic duct opening → increased gallbladder wall tension and pressure → pain

As the gallbladder relaxes, the stones often fall back into the gallbladder, and the pain subsides within 30 to 90 minutes.

Clinical Features

• Intermittent RUQ pain that increases in intensity following the ingestion of fat.
• Lasts for minutes – hours.
• Nausea, bloating, vomiting.
• May radiate to the back.
• NORMAL physical exam in uncomplicated

Investigation findings

• FBC normal in uncomplicated
• LFT: uncomplicated = normal, obstruction ALP >200 IU/L, ALP >3x ALT
• Abdo USS: gall stones, sludge