Patients presenting with right upper quadrant pain don’t always need an extensive workup before surgical consultation.
According to general surgeon Zachary Parshall, MD, early referral for suspected benign biliary disease can prevent the need for emergency interventions later on.
Clinical presentation
Benign biliary disease encompasses three main categories:
- Gallstones are causing symptoms.
- Elevated liver enzymes or a history of stones.
- Biliary dyskinesia – pain without stones that appears gallbladder-related.
Patients typically report epigastric or right upper quadrant pain, often accompanied by nausea, vomiting or diarrhea.
While symptoms frequently correlate with food intake, Dr. Parshall notes that many patients experience pain randomly, regardless of meals.
Diagnostic approach
For any patient with right upper quadrant pain suggestive of gallbladder pathology, Dr. Parshall recommends starting with an ultrasound.
“If they have stones, we’ll see them and talk about it. If they don’t have stones or the ultrasound is normal – there are no problems with the gallbladder, liver or bile ducts – and you still think it’s biliary, we’re happy to see them.”
If the ultrasound is normal but clinical suspicion remains high for biliary disease, a HIDA scan can evaluate for biliary dyskinesia. However, Dr. Parshall emphasizes that an extensive workup isn’t necessary before referral.
“We just prefer they have the ultrasound before, so we have something to work with,” he says.
When to refer
Dr. Parshall, who practices at Bellevue Medical Center, encourages referral after an initial ultrasound, whether stones are present or not. Early surgical consultation allows for shared decision-making about treatment options before symptoms escalate.
“We’d rather see someone first and prevent them from having emergency surgery in the ER six months later,” Dr. Parshall says. “It’s always better to talk sooner than later.”
The severity of symptoms shouldn’t be a barrier to referral. Dr. Parshall welcomes consultations for any abdominal pain potentially related to the gallbladder, even when symptoms are mild.
Treatment landscape
Current surgical treatments for benign biliary disease typically involve outpatient laparoscopic cholecystectomy with favorable outcomes.
Dr. Parshall emphasizes that the goal is collaborative discussion about the best management strategy for each patient.
“We’re happy to see these patients and talk about options, even if it doesn’t lead to surgery,” Dr. Parshall says. “We want to be involved with helping people out.”
For referrals or additional information, email physicianoutreach@nebraskamed.com or call 402.559.2500.