Management

Emergency department (ED) management depends on the severity of the gall stone disease and the patient’s symptoms.

If pain has settled from an acute attack of biliary colic, the patient may be discharged from the ED.

If pain is ongoing, the diagnosis may be early acute cholecystitis or complications of gall stone disease. If there is any evidence of haemodynamic instability, a senior ED physician should be involved.

Resuscitation (if dehydrated or signs of sepsis)

• 

  High-concentration oxygen delivered by high flow oxygen and oxygen mask with reservoir bag

• Two large bore peripheral intravenous cannulae
• Blood tests
• Urinary catheter and measure urine volumes
• Urgent referral to senior surgeon and critical care if instability persists

Analgesia

Give opiate analgesia as appropriate. Do not withhold analgesia pending surgical review [13].

Antibiotics

Intravenous broad-spectrum antibiotics should be given if there are signs of sepsis, acute cholecystitis or complicated gall bladder disease.

Antibiotic use will vary according to local policy. The most commonly used are piperacillin with tazobactam, third-generation cephalosporin or co-amoxiclav.

Nil by mouth

Keep nil by mouth and involve surgical and radiological teams.