Gallstone disease diagnostic study of choice: Difference between revisions
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{{Gallstone disease}} | {{Gallstone disease}} | ||
==Overview== | ==Overview== | ||
Patients who present with right upper quadrant pain are suspected of having gallstone disease. The patients symptoms are usually accompanied by a normal physical examination and normal laboratory results including those for leukocytosis and pancreatic enzyme levels. | The best modality for detecting gallstones is a transabdominal [[ultrasound]] (TAUS). Patients who present with [[right upper quadrant pain]] are suspected of having gallstone disease. The patients symptoms are usually accompanied by a normal physical examination and normal laboratory results including those for [[leukocytosis]] and [[pancreatic]] [[enzyme]] levels. In [[Obesity|obese]] patients, or patients where imaging is practically difficult an esophageal [[ultrasound]] (EUS) with high [[Sensitivity (tests)|sensitivity]] may be used. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
===Gold standard/Study of choice:=== | ===Gold standard/Study of choice:=== | ||
*Transabdominal ultrasound is the gold standard test for the diagnosis of gallstone disease. | *Transabdominal [[ultrasound]] (TAUS) is the gold standard test for the diagnosis of gallstone disease.<ref name="pmid981625">{{cite journal |vauthors=Leopold GR, Amberg J, Gosink BB, Mittelstaedt C |title=Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques |journal=Radiology |volume=121 |issue=2 |pages=445–8 |year=1976 |pmid=981625 |doi=10.1148/121.2.445 |url=}}</ref><ref name="pmid108978">{{cite journal |vauthors=Conrad MR, Janes JO, Dietchy J |title=Significance of low level echoes within the gallbladder |journal=AJR Am J Roentgenol |volume=132 |issue=6 |pages=967–72 |year=1979 |pmid=108978 |doi=10.2214/ajr.132.6.967 |url=}}</ref><ref name="pmid3263025">{{cite journal |vauthors=Brink JA, Simeone JF, Mueller PR, Richter JM, Prien EL, Ferrucci JT |title=Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy |journal=AJR Am J Roentgenol |volume=151 |issue=5 |pages=927–31 |year=1988 |pmid=3263025 |doi=10.2214/ajr.151.5.927 |url=}}</ref><ref name="pmid6769957">{{cite journal |vauthors=Filly RA, Allen B, Minton MJ, Bernhoft R, Way LW |title=In vitro investigation of the origin of echoes with biliary sludge |journal=J Clin Ultrasound |volume=8 |issue=3 |pages=193–200 |year=1980 |pmid=6769957 |doi= |url=}}</ref><ref name="pmid3275565">{{cite journal |vauthors=Lee SP, Maher K, Nicholls JF |title=Origin and fate of biliary sludge |journal=Gastroenterology |volume=94 |issue=1 |pages=170–6 |year=1988 |pmid=3275565 |doi= |url=}}</ref> | ||
*The following result of transabdominal ultrasound is confirmatory of gallstone disease: | *The following result of transabdominal [[ultrasound]] is confirmatory of gallstone disease: | ||
**Solitary or multiple stones in the gallbladder or another site within the biliary tree | **Solitary or multiple stones in the [[gallbladder]] or another site within the [[biliary tree]]. | ||
**Sludge or gravel seen within the gallbladder | **Sludge or gravel seen within the [[Gallbladder|gallbladder.]] | ||
*The transabdominal ultrasound should be performed when: | *The transabdominal [[ultrasound]] should be performed when: | ||
**The patient presented with symptoms/signs abdominal pain, jaundice and fever | **The patient presented with [[Symptom|symptoms]]/[[Medical sign|signs]] of [[abdominal pain]], [[jaundice]] and [[fever]]. | ||
*Investigations: | *Investigations: | ||
**Among patients who present with clinical signs of gallstone disease, the transabdominal ultrasound is the most specific test for the diagnosis. | **Among patients who present with clinical signs of gallstone disease, the transabdominal [[ultrasound]] is the most [[Specificity (tests)|specific]] test for the diagnosis. | ||
**Gallstones appear as echogenic foci that cast an acoustic shadow and exhibit | **Gallstones appear as [[Echogenicity|echogenic]] foci that cast an [[acoustic shadow]] and exhibit gravitational dependence. | ||
**Gravel has a similar appearance to stones and are also echogenic and cast shadows. | **Gravel has a similar appearance to stones and are also echogenic and cast shadows. | ||
**Sludge is echogenic but does not cast shadows. | **Sludge is [[Echogenicity|echogenic]] but does not cast [[Acoustic shadow|shadows]]. | ||
==== The comparison table for diagnostic | ==== The comparison table for diagnostic study of choice for gallstone disease<ref name="pmid7979854">{{cite journal |vauthors=Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS |title=Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease |journal=Arch. Intern. Med. |volume=154 |issue=22 |pages=2573–81 |year=1994 |pmid=7979854 |doi= |url=}}</ref> ==== | ||
{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! style="background: # | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test characteristic | ||
! 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;" | | ! style="background: #696969; color: #FFFFFF; text-align: center;" |TAUS | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |84% | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |99% | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | |||
|} | |} | ||
=====Diagnostic results===== | =====Diagnostic results===== | ||
The following result of transabdominal ultrasound is confirmatory of gallstone disease: | The following result of transabdominal ultrasound is confirmatory of gallstone disease:<ref name="pmid981625">{{cite journal |vauthors=Leopold GR, Amberg J, Gosink BB, Mittelstaedt C |title=Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques |journal=Radiology |volume=121 |issue=2 |pages=445–8 |year=1976 |pmid=981625 |doi=10.1148/121.2.445 |url=}}</ref><ref name="pmid108978">{{cite journal |vauthors=Conrad MR, Janes JO, Dietchy J |title=Significance of low level echoes within the gallbladder |journal=AJR Am J Roentgenol |volume=132 |issue=6 |pages=967–72 |year=1979 |pmid=108978 |doi=10.2214/ajr.132.6.967 |url=}}</ref><ref name="pmid3263025">{{cite journal |vauthors=Brink JA, Simeone JF, Mueller PR, Richter JM, Prien EL, Ferrucci JT |title=Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy |journal=AJR Am J Roentgenol |volume=151 |issue=5 |pages=927–31 |year=1988 |pmid=3263025 |doi=10.2214/ajr.151.5.927 |url=}}</ref> | ||
*Solitary or multiple stones in the gallbladder or another site within the biliary tree | *Solitary or multiple stones in the [[gallbladder]] or another site within the [[biliary tree]]. | ||
*Sludge or gravel seen within the [[gallbladder]]. | |||
=====Sequence of Diagnostic Studies===== | =====Sequence of Diagnostic Studies===== | ||
The transabdominal ultrasound should be performed when: | The transabdominal [[ultrasound]] should be performed when: | ||
*The patient presented with symptoms/signs of biliary colic or jaundice or fever as the first step of diagnosis. | *The patient presented with [[Symptom|symptoms]]/[[Medical sign|signs]] of [[Gallstone disease history and symptoms|biliary colic]] or [[jaundice]] or [[fever]] as the first step of diagnosis. | ||
*A positive result is the visualization of stones | *A positive result is the visualization of stones in the patient. | ||
=== Diagnostic Criteria === | === Diagnostic Criteria === | ||
* | *There is no particular established diagnostic criteria for gallstone disease. | ||
*[[Diagnosis]] is based upon [[Medical history|history]], [[Symptom|symptoms]] and possibly, gallstone detection with transabdominal [[ultrasound]]. | |||
* | [[Image:Acute-cholecystitis-with-gallbladder-neck-calculus (1).jpg|thumb|center|500px|Case courtesy of radiopaedia.org by Dr Derek Smith, from the case <ahref="https://radiopaedia.org/cases/42795">rID: 42795</a>]] | ||
==References== | |||
{{Reflist|2}} | |||
{{WH}} | |||
{{WS}} | |||
[[Category:Gastroenterology]] | |||
[[Category:Hepatology]] | |||
[[Category:Surgery]] | |||
[[Category:Disease]] | |||
Latest revision as of 21:48, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
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Overview
The best modality for detecting gallstones is a transabdominal ultrasound (TAUS). Patients who present with right upper quadrant pain are suspected of having gallstone disease. The patients symptoms are usually accompanied by a normal physical examination and normal laboratory results including those for leukocytosis and pancreatic enzyme levels. In obese patients, or patients where imaging is practically difficult an esophageal ultrasound (EUS) with high sensitivity may be used.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Transabdominal ultrasound (TAUS) is the gold standard test for the diagnosis of gallstone disease.[1][2][3][4][5]
- The following result of transabdominal ultrasound is confirmatory of gallstone disease:
- Solitary or multiple stones in the gallbladder or another site within the biliary tree.
- Sludge or gravel seen within the gallbladder.
- The transabdominal ultrasound should be performed when:
- The patient presented with symptoms/signs of abdominal pain, jaundice and fever.
- Investigations:
- Among patients who present with clinical signs of gallstone disease, the transabdominal ultrasound is the most specific test for the diagnosis.
- Gallstones appear as echogenic foci that cast an acoustic shadow and exhibit gravitational dependence.
- Gravel has a similar appearance to stones and are also echogenic and cast shadows.
- Sludge is echogenic but does not cast shadows.
The comparison table for diagnostic study of choice for gallstone disease[6]
| Test characteristic | Sensitivity | Specificity |
|---|---|---|
| TAUS | 84% | 99% |
Diagnostic results
The following result of transabdominal ultrasound is confirmatory of gallstone disease:[1][2][3]
- Solitary or multiple stones in the gallbladder or another site within the biliary tree.
- Sludge or gravel seen within the gallbladder.
Sequence of Diagnostic Studies
The transabdominal ultrasound should be performed when:
- The patient presented with symptoms/signs of biliary colic or jaundice or fever as the first step of diagnosis.
- A positive result is the visualization of stones in the patient.
Diagnostic Criteria
- There is no particular established diagnostic criteria for gallstone disease.
- Diagnosis is based upon history, symptoms and possibly, gallstone detection with transabdominal ultrasound.
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References
- ↑ 1.0 1.1 Leopold GR, Amberg J, Gosink BB, Mittelstaedt C (1976). "Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques". Radiology. 121 (2): 445–8. doi:10.1148/121.2.445. PMID 981625.
- ↑ 2.0 2.1 Conrad MR, Janes JO, Dietchy J (1979). "Significance of low level echoes within the gallbladder". AJR Am J Roentgenol. 132 (6): 967–72. doi:10.2214/ajr.132.6.967. PMID 108978.
- ↑ 3.0 3.1 Brink JA, Simeone JF, Mueller PR, Richter JM, Prien EL, Ferrucci JT (1988). "Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy". AJR Am J Roentgenol. 151 (5): 927–31. doi:10.2214/ajr.151.5.927. PMID 3263025.
- ↑ Filly RA, Allen B, Minton MJ, Bernhoft R, Way LW (1980). "In vitro investigation of the origin of echoes with biliary sludge". J Clin Ultrasound. 8 (3): 193–200. PMID 6769957.
- ↑ Lee SP, Maher K, Nicholls JF (1988). "Origin and fate of biliary sludge". Gastroenterology. 94 (1): 170–6. PMID 3275565.
- ↑ Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS (1994). "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease". Arch. Intern. Med. 154 (22): 2573–81. PMID 7979854.