gallstones & biliary colic: gp assessment, analgesia, and referral

Biliary colic classically causes episodic RUQ/epigastric pain (often post-fatty meal), sometimes radiating to the back/right shoulder, with nausea/vomiting. The primary care risk is missing complications: acute cholecystitis, ascending cholangitis, or acute pancreatitis.

• Uncomplicated biliary colic: severe pain lasting minutes–hours, afebrile, improves between episodes.
• Acute cholecystitis: persistent RUQ pain >6 hours, fever, RUQ tenderness/positive Murphy’s, raised inflammatory markers.
• Ascending cholangitis: fever + jaundice + RUQ pain (Charcot triad), can deteriorate rapidly → emergency.
• Pancreatitis: severe epigastric pain radiating to back, vomiting, systemic unwellness; check amylase/lipase in hospital pathway.

• Bloods: FBC, CRP, LFTs, U&E; consider amylase if available locally (but suspected pancreatitis generally needs ED).
• Imaging: ultrasound is first-line for gallstones; many areas arrange via surgical/gastro pathway.
• Analgesia: NSAIDs are often effective (if safe) ± opioid. Antiemetic if needed. Avoid delaying referral if recurrent.

Diet: short-term reduction in fatty foods may reduce attacks but is not definitive treatment.

• Same-day ED: suspected cholecystitis, cholangitis, pancreatitis, sepsis, persistent vomiting/dehydration, or jaundice.
• Elective surgical referral: recurrent biliary colic, complications history, or patient preference with documented stones.