282 Audit for the Management of Acute Gallstone Disease

Abstract

Aim The aim of this audit was to investigate how patients referred by the Emergency Department (ED) with biliary disease were managed. Also, to identify a cohort of patients which could be safely discharged from ED with an outpatient US and follow up with the Surgical Assessment Unit.

Method Data was collected from 23/11/20 to 11/12/20. The inclusion criteria were patients referred by ED with abdominal pain and a diagnosis of biliary disease. Data collected included blood results, US results and if they underwent a laparoscopic cholecystectomy (LC).

Results There were 22 patients identified; 5 had biliary colic, 4 had cholangitis and 13 had cholecystitis.

The 5 patients with biliary colic had almost completely normal bloods on admission. While 16/17 patients with cholecystitis/cholangitis had elevated FBC, CRP or LFTs.

US was performed on 3 patients with biliary colic within 3 days of ED attendance. US was performed on 16/17 patients with cholecystitis/cholangitis, mainly within 2 days.

None of the patients with biliary colic received antibiotics and 2 had an inpatient LC. All patients with cholecystitis and cholangitis were admitted and treated with antibiotics. 1 patient with cholecystitis had a LC and 7 were on the waiting list.

Conclusions This has shown that patients are being imaged with US efficiently and are treated appropriately with antibiotics. It has demonstrated that a blood test in ED is effective at differentiating between biliary colic and other diseases that require admission. However, improvements need to be made to increase access for patients to undergo timely LCs.