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Pain is the single most common reason patients seek care in the emergency department. (1) Given the prevalence of pain as a presenting complaint, one might expect emergency physicians to [...]

PURPOSE: Patients with gallstones who have recently experienced biliary tract pain are likely to develop recurrent symptoms in the near future. As a consequence, most symptomatic patients are offered specific treatment. However, disagreement persists regarding which symptom, and signs truly represent symptomatic cholelithiasis. We re-examined the relation of gastrointestinal complaints and physical findings to the presence of gallstones in a clinical population. PATIENTS AND METHODS: Over a 2-year period, we identified outpatients of a public teaching hospital for whom diagnostic studies of the gallbladder had been ordered. Patients were interviewed and examined by research personnel prior to completion of the studies. Gastrointestinal symptoms and physical examination findings in 122 patients found to have gallstones were contrasted with those of 178 gallstone-free patients. RESULTS: In comparison to control subjects, patients with gallstones more often reported epigastric pain lasting at least 30 minutes (64.2% versus 45.1 %, p [less than] 0.004). The latter patients infrequently complained of lower abdominal Pain (12.3% versus 29.9%, p [less than] 0.002), but more often described Pain radiating to the upper back. Gallstone-associated pain usually occurred more than 1 hour after meals. persisted from 1 to 24 hours, and was steady in quality. Although these differences were statistically significant, likelihood ratio analysis indicated that clinical symptoms and signs were relatively weak discriminators of gallbladder disease. CONCLUSIONS: Upper abdominal pain is the symptom most closely associated with gallstone disease. Radiation to the upper back, a steady quality, duration between 1 and 24 hours, and onset more than an hour after meals support the diagnosis. Nevertheless, gallstone-associated symptoms are non-specific, and accurate diagnosis cannot rely on the clinical assessment alone. Careful clinical evaluation can guide patient selection for diagnostic imaging and the appropriate management of those found to harbor stones., Gallstone disease may be associated with symptoms of pain in the biliary tract, the ducts and organs involved in storing and secreting bile into the duodenum, the first segment of the small intestine. Cholecystectomy, the removal of the gallbladder, may be required to prevent the recurrence of pain. However, the signs and symptoms of cholelithiasis, the formation of gallstones, have not been clarified. The relation of gastrointestinal symptoms and physical findings to gallstone disease was assessed in 300 patients who underwent gallbladder tests. Epigastric pain, pain in the area above the stomach, which lasted at least 30 minutes, occurred in 122 patients with gallstones, compared with the 178 patients without gallstones. Patients with gallstones rarely developed lower abdominal pain, but experienced pain that spread to the upper back. The pain associated with gallstone disease often developed one hour after meals and lasted from one to 24 hours. These signs and symptoms were weak indicators of the disease. The results show that upper abdominal pain is the most common symptom associated with gallstone disease. Supportive of a diagnosis of gallstone disease include pain that radiates to the upper back, has a steady or persistent nature, lasts between one and 24 hours, and begins more than an hour after meals. However, symptoms of gallstone disease are generally nonspecific, and clinical assessment alone is not sufficient to make a diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Byline: Knox H Todd, Joan S Harris, B.Tilman Jolly, Jeffrey W Runge, Knox H Todd Author Affiliation: Rollins School of Public Health, Emory University, Atlanta, GA National Highway Traffic Safety Administration Department of Emergency Medicine, George Washington University, Washington DC Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC Rollins School of Public Health, Emory University, Atlanta, GA Article Note: (footnote) [star] Reprints not available from the editors., [star][star] 47/1/94482

Byline: B.Tilman Jolly, Joan S Harris, B.Tilman Jolly, Jeffrey W Runge, Knox H Todd Author Affiliation: Department of Emergency Medicine George Washington University Medical Center Washington DC National Highway Traffic Safety Administration Department of Emergency Medicine George Washington University Washington DC Department of Emergency Medicine Carolinas Medical Center Charlotte, NC Rollins School of Public Health, Emory University Atlanta, GA Article Note: (footnote) [star] Effect of Increased Speed Limits in the Post-NMSL Era, [star][star] National Highway Traffic Safety Administration, a Commentary: Does Speed Really Kill, aa Reprint no. 47/1/91668 , acents Reprints not available from the editors.