Lab findings include leukocytosis with left shift, increased direct and indirect bilirubin, elevated alkaline phosphatase, and bile in urine. Ultrasound or HIDA scan may show stones. Pain is usually mid-epigastric occasionally with radiation through to back. Often characterized as burning, episodic, gnawing, relieved by antacids, may increase or decrease after food. Exam reveals normal bowel sounds, epigastric tenderness, and guaiac positive stools with bleeding.
Laboratory tests are unchanged.
UGI or endoscopy may be diagnostic. Significant complications include bleeding, outlet obstruction and perforation. Bleeding patients may present with hypotension, hematemesis, melena, and positive guaiac. Outlet obstruction will often cause vomiting and pain after eating. Perforation causes severe abdominal pain, hypotension, guarding, rebound, free air and ileus on x-ray of abdomen.