A severe, persistent pain in the upper right abdomen may indicate a gallbladder attack, medically known as biliary colic, which occurs when gallstones temporarily block the cystic duct. If the blockage continues, it can lead to inflammation of the gallbladder, a more serious condition called acute cholecystitis. When this intense pain does not subside, or if it is accompanied by fever or vomiting, it signals a need for immediate emergency room (ER) attention. The ER’s primary goal is to quickly confirm the diagnosis, manage the pain, and determine if an infection or complication requires urgent intervention.
Immediate Stabilization and Pain Management
Upon arrival at the emergency room, the medical team’s first priority is to stabilize the patient and control the severe discomfort. The initial assessment includes checking vital signs, such as heart rate, blood pressure, temperature, and respiratory rate, to quickly identify any signs of immediate distress or infection. An intravenous (IV) line is typically established to administer fluids, which helps to maintain hydration and electrolyte balance, especially if the patient has been vomiting.
The most pressing concern for the patient is often the intense pain, which can be described as sharp or gripping and may radiate to the back or right shoulder blade. To address this, the ER staff administers powerful analgesic medications, often through the IV line, to provide rapid relief. Medications to counteract nausea and vomiting, known as antiemetics, are also commonly given to prevent further dehydration. This initial phase focuses on symptom control to allow for a thorough diagnostic workup.
Confirming the Diagnosis: Tests Performed
Once the patient is stabilized and comfortable, the ER team focuses on confirming the diagnosis of a gallbladder issue and ruling out other causes of abdominal pain, such as appendicitis or pancreatitis. A physical examination, including checking for tenderness in the upper right abdomen, is performed, and a classic sign known as Murphy’s sign may be elicited. This involves pressing below the right rib cage while the patient breathes in, which causes a sharp increase in pain if the gallbladder is inflamed.
The abdominal ultrasound is the primary imaging tool used in the emergency setting because it is non-invasive and does not use radiation. The ultrasound allows the clinician to visualize the gallbladder for the presence of gallstones and to look for signs of inflammation, such as thickening of the gallbladder wall or fluid surrounding the organ. This imaging is highly sensitive for detecting gallstones and acute cholecystitis.
Blood tests are drawn to provide internal clues about the body’s response to the attack.
- A Complete Blood Count (CBC) is performed to check the white blood cell count, as an elevated number can indicate infection or inflammation.
- Liver function tests are ordered to check for signs of a bile duct obstruction, which causes bilirubin and certain liver enzymes to back up into the bloodstream.
- Amylase and lipase levels may also be checked to ensure the inflammation has not extended to the pancreas, a condition known as gallstone pancreatitis.
Evaluating for Severe Acute Conditions
The ER focuses on screening for complications beyond pain management. Acute cholecystitis can quickly lead to severe infection. The medical team identifies signs of sepsis, such as high fever, elevated white blood cell count, or abnormal vital signs. If these signs are present, immediate administration of broad-spectrum antibiotics is initiated to combat the infection.
The imaging and blood work help detect local complications within the biliary system. The team looks for signs that the gallbladder wall has become compromised, such as gangrene or perforation, which can spill infectious contents into the abdominal cavity. Such findings require emergency surgical consultation to prevent widespread infection of the abdomen, known as peritonitis. If blood tests show signs of jaundice or elevated liver enzymes, it may indicate a gallstone is blocking the main bile duct, requiring specialized treatment.
Determining Patient Disposition and Next Steps
After the diagnostic workup is complete, the ER physician must decide on the patient’s disposition. Patients are admitted for urgent treatment if their pain remains uncontrolled, if they show acute cholecystitis with signs of infection, or if they are unable to tolerate food or liquids. Admission allows for continued IV hydration, administration of antibiotics, and preparation for a cholecystectomy, which is the surgical removal of the gallbladder, often performed during that initial hospitalization.
Patients who have a simple gallbladder attack (biliary colic), where the pain resolves and there are no signs of infection or severe inflammation, may be candidates for discharge. Before leaving, patients receive instructions, such as dietary modifications to reduce fat intake, and education on recognizing warning signs like recurrent severe pain or fever. They are given a referral for timely follow-up with a surgeon to schedule an elective gallbladder removal, as delaying surgery increases the risk of returning to the ER with a more severe complication.