Gallbladder neck becomes impacted by a gallstone

Aetiology

• See Gallstones

Pathophysiology

• Contraction of the gallbladder against the occluded neck results in colicky pain
• No inflammatory response

Clinical features

• Gradual build-up pain in RUQ, often exacerbated by eating
• Pain radiates to back/shoulder
• Associated with indigestion/nausea

Investigations

• Imaging:
  • USS
  • MRCP and/or ERCP if further clarification needed
• LFTs: ALP > ALT/AST, ↑ bilirubin

Management

• Painkillers
• Low fat diet, weight loss if obese
• If recurrent episodes of pain, consider cholecystectomy
• If recurrent episodes of pain and unfit for surgery - ursodeoxycholic acid