For example, RUQ pain that is post-prandial, that begins 30 minutes after a meal and lasts for 2 hours, radiates around the back, is dull in nature, and abates spontaneously is most likely biliary colic due to gallstones. Symptoms associated with acute cholecystitis are usually more acute and persistent. The patient may have a history of biliary colic, with the pain starting in the epigastrium, associated bloating or belching. Subsequently, the pain may worsen and radiate to the right upper quadrant. Patients may confuse these symptoms with heartburn.
Pertinent history can include use of antacids without relief of symptoms.
There also may be an associated fever. Occasionally a point of maximal tenderness may be in the RLQ or more epigastric depending on the anatomy of the patient. An elevated pulse rate or temperature may also go along with acute cholecystitis. Laboratory studies Laboratory studies to assist in narrowing the differential diagnosis will include a CBC, chem 20 including an AST, ALT, bilirubin, alkaline phosphatase, amylase, and urinalysis. A chest x-ray may also be helpful in identifying lower lobe pneumonia or finding free air under the diaphragm.