Difference between revisions of "Acute cholecystitis diagnostic study of choice"

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(Diagnostic Criteria)
(The comparison table for diagnostic studies of choice for [disease name])
 
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** The patient presented with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
 
** The patient presented with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
  
==== The comparison table for diagnostic studies of choice for [disease name] ====
+
==== The comparison table for diagnostic studies of choice for acute cholecystitis ====
 +
The table below summarizes the sensitivities and specificities of the diagnostic studies for acute cholecystitis.<ref name="pmid22798223">{{cite journal |vauthors=Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA |title=A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis |journal=Radiology |volume=264 |issue=3 |pages=708–20 |year=2012 |pmid=22798223 |doi=10.1148/radiol.12111561 |url=}}</ref>
 
{|
 
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
 
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
 
|-
 
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
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! style="background: #696969; color: #FFFFFF; text-align: center;" |Transabdominal Ultrasound✔✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |81%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |83%
 
|-
 
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
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! style="background: #696969; color: #FFFFFF; text-align: center;" |Cholescintigraphy(HIDA)✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |96%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
 +
|-
 +
! style="background: #696969; color: #FFFFFF; text-align: center;" |MRI
 +
| style="background: #DCDCDC; padding: 5px; text-align: center;" |85%
 +
| style="background: #DCDCDC; padding: 5px; text-align: center;" |81%
 +
 
 
|}
 
|}
<small> ✔= The best test based on the feature </small>
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<small> ✔= The best test based on the sensitivity and specificity ✔✔=Gold standard </small>
  
 
===== Sequence of Diagnostic Studies =====
 
===== Sequence of Diagnostic Studies =====
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**More time is needed for the tests
 
**More time is needed for the tests
 
**Limited availability
 
**Limited availability
 
  
 
=== Diagnostic Criteria ===
 
=== Diagnostic Criteria ===
 
{|
 
{|
|
 
 
| style="background:#F5F5F5;" + |
 
| style="background:#F5F5F5;" + |
The diagnostic criteria for acute cholecystitis is:
+
The diagnostic criteria for acute cholecystitis is:<ref name="pmid23340953">{{cite journal |vauthors=Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG |title=TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos) |journal=J Hepatobiliary Pancreat Sci |volume=20 |issue=1 |pages=35–46 |year=2013 |pmid=23340953 |doi=10.1007/s00534-012-0568-9 |url=}}</ref>
 +
 
 
A.Local signs of inflammation etc.
 
A.Local signs of inflammation etc.
 
*Murphy's sign
 
*Murphy's sign
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Suspected diagnosis: One item in A + one item in B
 
Suspected diagnosis: One item in A + one item in B
 +
 
Definite diagnosis: One item in A + one item in B + C
 
Definite diagnosis: One item in A + one item in B + C
  
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RUQ right upper abdominal quadrant, CRP C-reactive protein, WBC white blood cell
 
RUQ right upper abdominal quadrant, CRP C-reactive protein, WBC white blood cell
 
|-
 
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| style="background:#DCDCDC; + " |<small>'''Adopted from [http://onlinelibrary.wiley.com/doi/10.1007/s00534-012-0568-9/full]'''
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| style="background:#DCDCDC; + " |<small>'''Adopted from [http://onlinelibrary.wiley.com/doi/10.1007/s00534-012-0568-9/full Journal of Hepato-Biliary-Pancreatic Sciences]'''
 
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Latest revision as of 15:31, 8 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

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Overview

Transabdominal ultrasonography is the gold standard for the diagnosis of gallstones. Thickened gallbladder, gallstones or sludge, and pericholecystic fluid are the findings associated with transabdominal ultrasound in patients with acute cholecystitis.

Diagnostic Study of Choice

Gold standard/Study of choice:

  • Transabdominal ultrasonography is the gold standard for the diagnosis of gallstones.[1][2][3][4]
  • The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis:
    • Thickened gallbladder (>4 mm)
    • Gallstones or sludge
    • Pericholecystic fluid
  • The ultrasound should be performed when:
    • The patient presented with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.

The comparison table for diagnostic studies of choice for acute cholecystitis

The table below summarizes the sensitivities and specificities of the diagnostic studies for acute cholecystitis.[5]

Test Sensitivity Specificity
Transabdominal Ultrasound✔✔ 81% 83%
Cholescintigraphy(HIDA)✔ 96% 90%
MRI 85% 81%

✔= The best test based on the sensitivity and specificity ✔✔=Gold standard

Sequence of Diagnostic Studies

There is no specific sequence of the diagnostic studies for acute cholecystitis.[3][4]

  • The transabdominal ultrasonography should be performed when:
    • The presented with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
    • A positive transabdominal ultrasonography is detected in the patient, to confirm the diagnosis.
  • Cholescintigraphy is an alternative method of imaging and uses technetium-labeled hepatic 2,6-dimethyl-iminodiacetic acid (HIDA) in difficult cases or uncertain diagnosis.
    • HIDA is injected intravenously and taken up by the liver. HIDA is excreted in the bile and therefore, can visualize hepatobiliary tree.
  • MRI and CT scan can also be used for the diagnosis of acute cholecystitis and it's complications. These modalities are not preferred because:
    • More time is needed for the tests
    • Limited availability

Diagnostic Criteria

The diagnostic criteria for acute cholecystitis is:[6]

A.Local signs of inflammation etc.

  • Murphy's sign
  • RUQ mass/pain/tenderness

B. Systemic signs of inflammation etc.

  • Fever
  • Elevated CRP
  • Elevated WBC count

C. Imaging findings

  • Imaging findings characteristic of acute cholecystitis

Suspected diagnosis: One item in A + one item in B

Definite diagnosis: One item in A + one item in B + C

Acute hepatitis, other acute abdominal diseases, and chronic cholecystitis should be excluded RUQ right upper abdominal quadrant, CRP C-reactive protein, WBC white blood cell

Adopted from Journal of Hepato-Biliary-Pancreatic Sciences

References

  1. "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf". 
  2. Foard DE, Haber AH (1970). "Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds". Radiat. Res. 42 (2): 372–80. PMID 5442405. 
  3. 3.0 3.1 Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. PMID 24679431. doi:10.1016/j.suc.2014.01.005. 
  4. 4.0 4.1 Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. PMC 5442405Freely accessible. PMID 28603584. doi:10.4240/wjgs.v9.i5.118. 
  5. Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA (2012). "A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis". Radiology. 264 (3): 708–20. PMID 22798223. doi:10.1148/radiol.12111561. 
  6. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG (2013). "TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)". J Hepatobiliary Pancreat Sci. 20 (1): 35–46. PMID 23340953. doi:10.1007/s00534-012-0568-9. 

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