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Biliary calculus
Other Resources UpToDate PubMed

Biliary calculus

Contributors: Michael W. Winter MD, Nishant H. Patel MD, Desiree Rivera-Nieves MD, Khaled Bittar MD
Other Resources UpToDate PubMed


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.


K80.20 – Calculus of gallbladder without cholecystitis without obstruction

266474003 – Calculus in biliary tract

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Biliary colic
  • Acute Acute cholecystitis
  • Acute pancreatitis or Chronic pancreatitis
  • Acute coronary syndrome
  • Gastritis
  • Gastroparesis
  • Hiatal hernia
  • Esophagitis
  • Esophageal spasm (see Esophageal motility disorder)
  • Gastroenteritis
  • Malignancy (particularly Esophageal carcinoma, Gastric cancer, small bowel, Pancreatic carcinoma, Liver cancer)
  • Zollinger-Ellison syndrome
  • Acute hepatitis (eg, Hepatitis A virus infection, Hepatitis B virus infection, Hepatitis C virus infection)
  • Acute appendicitis
  • Pyelonephritis
  • Renal calculus
  • Mesenteric ischemia (Acute mesenteric ischemia, Chronic mesenteric ischemia)
  • Liver abscess (eg, Pyogenic liver abscess, Amebic liver abscess)
  • 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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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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Last Updated:05/18/2020
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Patient Information for Biliary calculus
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Biliary calculus
Imaging Studies image of Biliary calculus - imageId=7878647. Click to open in gallery.  caption: '<span>Ultrasound of the right upper  quadrant demonstrating echogenic foci with shadowing in the gallbladder  consistent with cholelithiasis.</span>'
Ultrasound of the right upper quadrant demonstrating echogenic foci with shadowing in the gallbladder consistent with cholelithiasis.
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