Q: How a pain of biliary colic and acute cholecystitis can be differentiated?
Answer: Pain in biliary colic is described as dull discomfort but of high intensity. It usually stayed in the parameter of Right Upper Quadrant (RUQ) or epigastrium and may be associated with nausea, vomiting, and diaphoresis. Most importantly, it lasts for 30 minutes, plateau within one hour, and other abdominal exam remains normal.
Pain in acute cholecystitis stays for more than 4 to 6 hours in RUQ or epigastric area and accompanied by fever. Associated abdominal exam shows guarding and positive Murphy's sign.
C. David Naylor. Physical Examination of the Liver. AMA. 1994;271(23):1859-1865