Biliary calculus
Alerts and Notices
Synopsis

Hardened crystal deposits formed from bile pigments, cholesterol, and calcium salts found in the bile duct (choledocholithiasis) or gallbladder (cholecystolithiasis). Commonly called gallstones, they are characterized by severe right upper quadrant abdominal pain or epigastric pain due to transient obstruction of the biliary tract. Other symptoms include nausea, vomiting, hyperbilirubinemia, and elevated alkaline phosphatase and gamma-glutamyl transpeptidase. Gallstones most typically occur in females in the fourth decade of life. They are increased during pregnancy, although they are relatively common and can occur in patients of all ages and across many demographics.
Treatment depends on size, location, and symptoms. Gallstones may end up in the duodenum or pylorus, which may result in gastric outlet obstruction (Bouveret syndrome). Common treatments are stone removal by endoscopic retrograde cholangiopancreatography, sphincterotomy, biliary stenting, and cholecystectomy. Goals of therapy are to prevent recurrent episodes of biliary colic and lower the risk of developing choledocholithiasis, cholangitis, and gallstone pancreatitis.
Treatment depends on size, location, and symptoms. Gallstones may end up in the duodenum or pylorus, which may result in gastric outlet obstruction (Bouveret syndrome). Common treatments are stone removal by endoscopic retrograde cholangiopancreatography, sphincterotomy, biliary stenting, and cholecystectomy. Goals of therapy are to prevent recurrent episodes of biliary colic and lower the risk of developing choledocholithiasis, cholangitis, and gallstone pancreatitis.
Codes
ICD10CM:
K80.20 – Calculus of gallbladder without cholecystitis without obstruction
SNOMEDCT:
266474003 – Calculus in biliary tract
K80.20 – Calculus of gallbladder without cholecystitis without obstruction
SNOMEDCT:
266474003 – Calculus in biliary tract
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Biliary colic
- Acute cholecystitis
- Acute or chronic pancreatitis
- Acute coronary syndrome
- Gastritis
- Gastroparesis
- Hiatal hernia
- Esophagitis
- Esophageal spasm (see esophageal motility disorder)
- Gastroenteritis
- Malignancy (particularly esophageal, gastric, small bowel, pancreatic, liver)
- Zollinger-Ellison syndrome
- Acute hepatitis (eg, hepatitis A, B, C)
- Acute appendicitis
- Pyelonephritis
- Nephrolithiasis
- Mesenteric ischemia (acute, chronic)
- Liver abscess (eg, pyogenic, amebic)
- Celiac disease
- Drug side effects (NSAIDs, alcohol, caffeine, antibiotics, corticosteroids, opiates, digoxin)
- Inflammatory bowel disease (ulcerative colitis, Crohn disease)
- Irritable bowel syndrome
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:05/18/2020

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