Acute cholecystitis diagnostic study of choice
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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.
- 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 [disease name]
✔= The best test based on the feature
Sequence of Diagnostic Studies
- 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
- "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
- 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.
- 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.
- 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 . PMID 28603584. doi:10.4240/wjgs.v9.i5.118.
The diagnostic criteria for acute cholecystitis is: A. Local signs of inflammation etc.
(1) Murphy's sign, (2) RUQ mass/pain/tenderness
B. Systemic signs of inflammation etc.
(1) Fever, (2) elevated CRP, (3) 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
|Adopted from Genetics in medicine|