Approach to Patients with Right Upper Quadrant Pain

Symptoms related to complications of gall stone disease are as follows:

• Pain from gall stone pancreatitis presents in a similar way to that caused by alcohol (i.e. epigastric or diffuse abdominal pain radiating to the back associated with nausea and vomiting)
• Ascending cholangitis, gall bladder empyema and gall bladder gangrene and perforation present in a similar way, with fever, severe RUQ pain and signs of severe sepsis

Ascending cholangitis is a life-threatening emergency, with an untreated mortality near 100%. The Charcot triad of fever, RUQ pain and jaundice is noted in only 25% of patients with ascending cholangitis [5].

The images illustrates a liver with the gall bladder exposed.

Learning Bite

Patients with ascending cholangitis can become very ill, very quickly.