🔪 General SurgeryHepatobiliary / GIStudentInternResident

Acute Cholecystitis & Biliary Colic

Also known as: gallbladder inflammation · biliary colic · gallstone disease · cholelithiasis

Inflammation of the gallbladder, usually from an obstructing gallstone — constant right-upper-quadrant pain, fever and a positive Murphy's sign. Biliary colic is transient pain from a stone WITHOUT inflammation.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Classically 'fat, female, forty and fertile'; also with rapid weight loss, haemolytic disease and diabetes.

Red flags — escalate / refer

Ascending cholangitis (Charcot's triad: right-upper-quadrant pain, fever and jaundice), sepsis, or gallstone pancreatitis → urgent care.

Work-up / diagnosis

1Bloods (FBC, LFTs, lipase/amylase, CRP) and abdominal ultrasound (stones, wall thickening, pericholecystic fluid).
2Consider MRCP if a common-bile-duct stone is suspected (deranged LFTs, dilated duct).

Management — overview

Analgesia, IV fluids and antibiotics per local policy for acute cholecystitis.
Early laparoscopic cholecystectomy — ideally during the same admission — is preferred for acute cholecystitis.
Ascending cholangitis needs urgent biliary drainage (ERCP) plus antibiotics; biliary colic is managed with analgesia and elective cholecystectomy.

In-depthFull dosing & advanced protocol

Drug dosing

Empirical antibiotics

Acute cholecystitis / cholangitis

Adult dose: Per local antibiogram / ICMR antimicrobial guidance
Route: IV then oral

Caution: De-escalate to culture results; cover biliary organisms.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Analgesia (paracetamol / NSAID / opioid as needed)

Pain control

Adult dose: Per protocol and severity
Route: Oral / IV

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Severity, timing and the duct

Grade severity and resuscitate; early (same-admission) laparoscopic cholecystectomy reduces complications versus delayed surgery.
Suspect a common-bile-duct stone with obstructive LFTs or a dilated duct — image (MRCP) and clear it (ERCP) as needed.
Cholangitis is a biliary emergency: antibiotics plus prompt drainage.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute AppendicitisAcute inflammation of the appendix — the commonest surgical acute abdomen. Classically peri-umbilical pain that migrates to the right iliac fossa. Prompt surgery prevents perforation.Acute Limb IschaemiaSudden loss of arterial perfusion to a limb — a surgical emergency. The 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold. Muscle and nerve injury begin within hours.Acute Compartment SyndromeRaised pressure within a closed fascial compartment cuts off perfusion — a limb-threatening surgical emergency. Pain out of proportion and pain on passive stretch are the earliest signs; fasciotomy is the treatment.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Empirical antibiotics

Analgesia (paracetamol / NSAID / opioid as needed)

📈 Severity, timing and the duct

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Empirical antibiotics

Analgesia (paracetamol / NSAID / opioid as needed)

📈 Severity, timing and the duct

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Severity, timing and the duct

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Severity, timing and the duct

References