Acute cholecystitis diagnostic study of choice: Difference between revisions

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{{Acute cholecystitis}}
{{Acute cholecystitis}}
== Overview ==
== 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.
[[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. Transabdominal [[ultrasonography]] is the '''initial study of choice''' for the diagnosis of acute cholecystitis and [[gallstones]]. [[Gallbladder wall thickening|Thickened gallbladder]], [[gallstones]] or sludge, and pericholecystic fluid are the findings associated with transabdominal [[ultrasound]] in patients with acute cholecystitis.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Gold standard/Study of choice: ===
=== Gold standard/Study of choice: ===
* Transabdominal ultrasonography is the gold standard for the diagnosis of gallstones.<ref name="urlGallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK459171/#article-19448.s5 |title=Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid5442405">{{cite journal |vauthors=Foard DE, Haber AH |title=Physiologically normal senescence in seedlings grown without cell division after massive gamma-irradiation of seeds |journal=Radiat. Res. |volume=42 |issue=2 |pages=372–80 |year=1970 |pmid=5442405 |doi= |url=}}</ref><ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref>
*[[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. Transabdominal [[ultrasonography]] is the '''initial study of choice''' for the diagnosis of acute cholecystitis and [[gallstones]].<ref name="urlGallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK459171/#article-19448.s5 |title=Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="urlImaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)">{{cite web |url=http://www.ajronline.org/doi/full/10.2214/AJR.10.4340 |title=Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR) |format= |work= |accessdate=}}</ref>
* The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis:
** The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis:
** Thickened gallbladder (>4 mm)
*** [[Gallbladder wall thickening|Thickened gallbladder]] (>4 mm)
** Gallstones or sludge
*** [[Gallstones]] or sludge
**Pericholecystic fluid
***Pericholecystic fluid
* The ultrasound should be performed when:
** The ultrasound should be performed when:
** The patient presented with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
*** The patient presents with [[right upper quadrant pain]], [[abdominal guarding]], [[Abdominal pain and fever|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;"
! 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
! 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
! 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>
<small> ✔= The best test based on the sensitivity and specificity ✔✔=Gold standard </small>


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
There is no specific sequence of the diagnostic studies for acute cholecystitis.<ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref>
There is no specific sequence of the diagnostic studies for acute cholecystitis. Ultrasound is the initial test performed in the suspected case of acute cholecystitis. Alternative tests are performed in diagnostic uncertainity.<ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref>
*The transabdominal ultrasonography should be performed when:
*The transabdominal [[ultrasonography]] is the '''initial study of choice''' and should be performed when:
** The presented with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
** The patient presents with [[right upper quadrant pain]], [[abdominal guarding]], [[Abdominal pain and fever|fever]], and a positive [[Murphy's sign]].
** A positive transabdominal ultrasonography is detected in the patient, to confirm the diagnosis.
** 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.
*[[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. [[Cholescintigraphy]] is an alternative method of imaging and uses technetium-labeled [[HIDA scan|hepatic 2,6-dimethyl-iminodiacetic acid]] ([[HIDA scan|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.
** [[HIDA scan|HIDA]] is injected intravenously and taken up by the liver. [[HIDA scan|HIDA]] is excreted in the bile and therefore, can visualize hepato-biliary 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:
*Abdominal [[Magnetic resonance imaging|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
**More time is needed for the tests
**Limited availability
**Limited availability


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
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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>
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]]
*RUQ mass/pain/tenderness
*RUQ mass/[[Right upper quadrant pain|pain/tenderness]]
B. Systemic signs of inflammation etc.
'''B.''' Systemic signs of inflammation etc.
*Fever
*[[Fever]]
*Elevated CRP
*Elevated [[CRP]]
*Elevated WBC count
*Elevated [[White blood cells|WBC]] count
C. Imaging findings
'''C.''' Imaging findings
*Imaging findings characteristic of acute cholecystitis
*Imaging findings characteristic of acute cholecystitis


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


Acute hepatitis, other acute abdominal diseases, and chronic cholecystitis should be excluded
*[[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
RUQ right upper abdominal quadrant, CRP C-reactive protein, WBC white blood cell
|-
|-
| style="background:#DCDCDC; + " |<small>'''Adopted from [http://onlinelibrary.wiley.com/doi/10.1007/s00534-012-0568-9/full]'''
| style="background:#DCDCDC; + " |<small>'''Adopted from [http://onlinelibrary.wiley.com/doi/10.1007/s00534-012-0568-9/full Journal of Hepato-Biliary-Pancreatic Sciences]'''
|-
|-
|}
|}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
{{WH}}
{{WS}}
[[Category: Gastroenterology]]

Latest revision as of 18:36, 8 February 2018


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

Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis and 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:

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. Ultrasound is the initial test performed in the suspected case of acute cholecystitis. Alternative tests are performed in diagnostic uncertainity.[3][2]

  • The transabdominal ultrasonography is the initial study of choice and should be performed when:
  • Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. 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 hepato-biliary tree.
  • Abdominal 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.

B. Systemic signs of inflammation etc.

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 Journal of Hepato-Biliary-Pancreatic Sciences

References

  1. ↑ "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
  2. ↑ 2.0 2.1 2.2 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. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.
  3. ↑ 3.0 3.1 Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.
  4. ↑ "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".
  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. doi:10.1148/radiol.12111561. PMID 22798223.
  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. doi:10.1007/s00534-012-0568-9. PMID 23340953.

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