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| ==Overview== | | ==Overview== |
| ==Cholescintigraphy== | | ==Other Diagnostic Studies== |
| Hepatobiliary [[nuclear medicine|scintigraphy]] with [[technetium]]-99m DISIDA ([[bilirubin]]) analog is also sensitive and accurate for diagnosis of chronic and acute cholecystitis. It can also assess the ability of the gallbladder to expel bile (gallbladder ejection fraction), and a low gallbladder ejection fraction has been linked to chronic cholecystitis. However, since most patients with right upper quadrant pain do not have cholecystitis, primary evaluation is usually accomplished with a modality that can diagnose other causes as well. <ref name="Shea">Shea, JA, Berlin, JA, Escarce, JJ, et al. ''Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease''. Arch Intern Med 1994; 154:2573.</ref> <ref name="Fink">Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. ''The sensitivity of hepatobiliary imaging and real time ultrasonography in the detection of acute cholecystitis''. Arch Surg 1985; 120:904.</ref>
| | *The histopathological analysis may be helpful in the diagnosis of chronic cholecystitis. Findings suggestive of chronic cholecystitis include:<ref name="Chronic cholecystitis">{{cite web |url=http://www.tandfonline.com/doi/full/10.1080/01913120490489441 |title=Chronic cholecystitis}}</ref> |
| | | ** Mononuclear inflammatory infiltrates and metaplasia |
| ===Calculous Cholecystitis===
| | ** Fibrosis |
| HIDA cholescintigraphy in acute cholecystitis will demonstrate nonvisualization of the gallbladder.
| | ** Lipid and mucolipid acuumulation in gallbladder wall |
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| ===Acalculous Cholecystitis===
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| The HIDA cholescintigraphy based diagnostic criteria from multiple studies for acalculous cholecystits is as follows.<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref>
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| {|class="wikitable"
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| ! Criteria!! Diagnosis
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| | RC<BR>MC || Nonvisualization of the gallbladder 1 hour after injection of radiolabeled technetium ([this is radionuclide cholescintigraphy (RC)]<br>Nonvisualization of the gallbladder 30 minutes after injection of morphine (after initial radiolabeled technetium) [this is morphine cholescintigraphy (MC)]
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| '''Diagnosis:''' RC alone or RC and MC.
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| ===Chronic Cholecystitis===
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| Signs of chronic cholecystitis on HIDA cholescintigraphy include delayed gallbladder isotope accumulation, irregular gallbladder filling, or photopenic areas and septations. A gallbladder ejection fraction of less than 35% after the administration of cholecystokinin indicates the presence of chronic calculus or chronic acalculous cholecystitis.<ref name="Chamarthy-2010">{{Cite journal | last1 = Chamarthy | first1 = M. | last2 = Freeman | first2 = LM. | title = Hepatobiliary scan findings in chronic cholecystitis. | journal = Clin Nucl Med | volume = 35 | issue = 4 | pages = 244-51 | month = Apr | year = 2010 | doi = 10.1097/RLU.0b013e3181d18ef5 | PMID = 20305411 }}</ref>
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |