Cholecystitis overview: Difference between revisions
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===CT=== | ===CT=== | ||
The reported sensitivity and specificity of [[computed axial tomography|CT scan]] findings are in the range of 90-95%. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and [[calculus (medicine)|calculi]] outside the [[lumen]] of the gallbladder. | The reported sensitivity and specificity of [[computed axial tomography|CT scan]] findings are in the range of 90-95%. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and [[calculus (medicine)|calculi]] outside the [[lumen]] of the gallbladder. | ||
===Ultrasound=== | |||
[[Ultrasound|Sonography]] is a sensitive and specific modality for diagnosis of acute cholecystitis; adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%, respectively. The 2 major diagnostic criteria are [[gallstone|cholelithiasis]] and sonographic [[Murphy's sign]]. Minor criteria include gall bladder wall thickening greater than 3mm, pericholecystic fluid, and gall bladder dilatation. <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> | |||
==References== | ==References== | ||
Revision as of 00:05, 3 February 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Cholecystitis is inflammation of the gall bladder.
Historical Perspective
Xanthogranulomatous cholecystitis (XGC) is a rare form of gall bladder disease which mimics gallbladder cancer although it is not cancerous. It was first discovered and reported in the medical literature in 1976 by J.J. McCoy, Jr., and colleagues.[1]. Eosinophilic cholecystitis was first described in 1949.[2].
Diagnosis
History and Symptoms
Cholecystitis usually presents as a pain in the right upper quadrant. This is usually a constant, severe pain. The pain may be felt to 'refer' to the right flank or right scapular region at first. This is usually accompanied by a low grade fever, vomiting and nausea. More severe symptoms such as high fever, shock and jaundice indicate the development of complications such as abscess formation, perforation or ascending cholangitis. Another complication, gallstone ileus, occurs if the gallbladder perforates and forms a fistula with the nearby small bowel, leading to symptoms of intestinal obstruction.
Chronic cholecystitis manifests with non-specific symptoms such as nausea, vague abdominal pain, belching, and diarrhea.
Physical Examination
Cholecystitis is usually diagnosed by a history of the above symptoms, as well examination findings like fever (usually low grade in uncomplicated cases) and tender right upper quadrant +/- Murphy's sign. Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes.
Laboratory Findings
Laboratory values may be notable for an elevated alkaline phosphatase, possibly an elevated bilirubin (although this may indicate choledocholithiasis), and possibly an elevation of the WBC. CRP (C-reactive protein) is often elevated. The degree of elevation of these laboratory values may depend on the degree of inflammation of the gall bladder. Patients with acute cholecystitis are much more likely to manifest abnormal laboratory values, while in chronic cholecystitis the laboratory values are frequently normal.
Electrocardiogram
Acute cholecystitis presents as pain the epigastrium which can be confused with acute myocardial infarction. ECG is useful in excluding MI.
CT
The reported sensitivity and specificity of CT scan findings are in the range of 90-95%. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and calculi outside the lumen of the gallbladder.
Ultrasound
Sonography is a sensitive and specific modality for diagnosis of acute cholecystitis; adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%, respectively. The 2 major diagnostic criteria are cholelithiasis and sonographic Murphy's sign. Minor criteria include gall bladder wall thickening greater than 3mm, pericholecystic fluid, and gall bladder dilatation. [3] [4]
References
- ↑ Makino I, Yamaguchi T, Sato N, Yasui T, Kita I (2009). "Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET". World Journal of Gastroenterology : WJG. 15 (29): 3691–3. PMC 2721248. PMID 19653352. Retrieved 2012-08-20. Unknown parameter
|month=ignored (help) - ↑ Dabbs DJ (1993). "Eosinophilic and lymphoeosinophilic cholecystitis". The American Journal of Surgical Pathology. 17 (5): 497–501. PMID 8470764. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ 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.
- ↑ 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.