What initial investigations are recommended for a patient presenting with suspected biliary colic?

Initial investigations recommended for a patient presenting with suspected biliary colic include:

• Offer liver function tests (LFTs) to assess for any abnormalities that may indicate biliary obstruction or liver involvement.
• Arrange an abdominal ultrasound scan to detect gallstones and assess the gallbladder and biliary tree.

If ultrasound does not detect common bile duct stones but there is a dilated bile duct and/or abnormal liver function tests, consider magnetic resonance cholangiopancreatography (MRCP) for further evaluation.

If MRCP is inconclusive, endoscopic ultrasound (EUS) may be considered to establish the diagnosis.

These investigations help confirm the diagnosis of gallstone disease and exclude other causes of abdominal pain.

Additionally, in primary care, appropriate analgesia such as NSAIDs (e.g., diclofenac) may be used to manage pain while awaiting further assessment.

Referral to secondary care is indicated if the patient is systemically unwell, has complications, or if pain cannot be managed in primary care.

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