I'm writing a story where a male character has gallstones. It happened to me a long time ago so I don't remember how they ran tests at the hospital to get to that diagnosis. I just remember the chest/back pain was terrible. How would they rule out a heart attack in the emergency room? What else would they test for? Are gall bladder stones common enough that a nurse or doctor thinks to check before an x-ray?
If the hospital is busy, how long is a patient allowed to be in severe pain until it warrants more meds (I've heard of morphine being used).
Cholecystitis (inflammation of the gallbladder, often related to gallstones) is a very common reason for abdominal pain. In fact, about 10-20% of Americans have gallstones, and about 1/3 of those will at some point have cholecystitis because of them.
Cholecystitis is very similar to appendicitis, just instead of the opening of the appendix getting blocked, the opening of the gallbladder does. About 90% of cholecystitis cases occur when a stone gets lodged in the tube that carries bile from the gallbladder to the small intestine.
While the pain is described as being abdominal, there is a lot of referred pain associated with the gallbladder, often in the shoulders, back, and chest. This can make it so that the person coming into the emergency room initially complains of pain in one of these areas.
If someone comes in and says their chest hurts, the hospital has to rule out something serious- like a heart attack or PE- before they can move on. Usually this involves taking bloodwork, doing an EKG, taking an X-ray or CT of the chest, and if anything comes of that, giving morphine and/or a beta blocker to reduce workload on the heart while setting up to go to the cath lab to remove the clot or place a chest tube.
If it's gallbladder pain, nothing is going to come of this- it's all going to come up normal, so they'll start working on other things. Usually this involves more bloodwork and more physical exam, as well as a CT of the abdomen.
The quickest and cheapest physical exam way to tell if someone's pain is caused by their gallbladder is to press straight down under the patient's ribcage on the right side, then tell the patient to take a deep breath. As the person breathes in, the diaphragm pushes down on the liver, which sandwiches the gallbladder between the liver and the examiner's hand, which hurts so much the person usually can't take the whole breath. This is called Murphy's sign.
As for how often the person might get pain meds- on a floor 2-6 hours depending on the med is standard- and they'll have to ask for them each time because of how they're ordered. In an emergency room, they're probably going to be lucky if they get them once, since in the ED, med doses are typically ordered individually.
Since cholecystitis isn't usually immediately life threatening, they'll either admit the person to a floor where they can get pain medicine until an OR opens up for a non-emergent slot, or they'll send the person home with some oral pain meds and schedule the surgery outpatient.
