Gallstone disease diagnostic study of choice
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
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. Typically, an evaluation will begin with a transabdominal ultrasound (TAUS) since it is the most sensitive modality for detecting gallstones.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Transabdominal ultrasound (TAUS) is the gold standard test for the diagnosis 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
- Sludge or gravel seen within the gallbladder
- The transabdominal ultrasound should be performed when:
- The patient presented with symptoms/signs 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.[1][2][3][4]
The comparison table for diagnostic study of choice for gallstone disease[5]
| Sensitivity | Specificity | |
|---|---|---|
| TAUS | 84% | 99% |
✔= The best test based on the feature
Diagnostic results
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
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 detected in the patient, to confirm the diagnosis.
Diagnostic Criteria
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- [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
- There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
- [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
IF there are clear, established diagnostic criteria:
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
- The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
- There are no established criteria for the diagnosis of [disease name].
References
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- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.