Version July 2025
HIDA: hepatobiliary iminodiacetic acid; RUQ: right upper quadrant.
* Acute biliary pain is typically located in the right upper quadrant, though may be epigastric or substernal. The pain is often associated with diaphoresis, nausea, and vomiting. Refer to related UpToDate content.
¶ Note that cholangitis, choledocholithiasis, and gallstone pancreatitis are also in the differential for acute biliary pain with these features. Refer to related UpToDate content.
Δ Refer to related UpToDate content on further evaluation in uncomplicated gallstone disease, which may require repeat RUQ ultrasound, or endoscopic ultrasound (EUS).
◊ HIDA is only done in hemodynamically stable patients, due to the length of time required to perform (hours).
§ Note that the diagnosis of acute acalculous cholecystitis is based on the clinical presentation and imaging findings and exclusion of alternative diagnoses. Imaging findings alone cannot make the diagnosis. Refer to related UptoDate content.
