Acute cholecystitis diagnostic study of choice

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

Acute cholecystitis Microchapters
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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.
• 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]

	Sensitivity	Specificity
Test 1	✔	...%
Test 2	...%	✔

✔= The best test based on the feature

Sequence of Diagnostic Studies

There is no specific sequence of the diagnostic studies for acute cholecystitis.

• 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: 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
Adopted from Genetics in medicine