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Initial Workup For Suspected Gallstones
- Order a hepatic function panel and a right upper quadrant ultrasound as initial tests for suspected symptomatic gallstones.
- Use ultrasound first because it best detects gallbladder stones and sludge.
Limit CT Use For Gallbladder Stones
- CT is insensitive for gallbladder stones and sludge compared with ultrasound.
- Use CT selectively to evaluate atypical diagnoses or complications like perforation.
When To Watch Versus Operate
- For patients with asymptomatic gallstones, watchful waiting is reasonable because only ~25% develop complications in 10 years.
- After a first biliary colic episode the risk of recurrent colic is ~30% and serious complications ~1–2%.