What are the recommended initial investigations for a patient presenting with suspected gallstones?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Recommended initial investigations for suspected gallstones include:

  • Offer liver function tests to assess for biliary obstruction or liver involvement.
  • Perform an abdominal ultrasound scan to detect gallstones and evaluate the gallbladder and biliary tree.
  • If ultrasound does not detect common bile duct stones but there is a dilated bile duct and/or abnormal liver function tests, consider magnetic resonance cholangiopancreatography (MRCP).
  • If MRCP is inconclusive, consider endoscopic ultrasound (EUS) for further evaluation.
  • In cases of suspected acute cholecystitis, additional blood tests such as white blood cell count, C-reactive protein, and serum amylase should be performed alongside ultrasound.

These investigations help confirm the diagnosis and guide further management or referral.

References: ,,

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