Acute cholecystitis diagnostic study of choice: Difference between revisions
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{{Acute cholecystitis}} | {{Acute cholecystitis}} | ||
== Overview == | == Overview == | ||
Transabdominal [[ultrasonography]] is the initial study of choice for the diagnosis of acute cholecystitis. [[Gallbladder wall thickening|Thickened gallbladder]], [[gallstones]] or sludge, and pericholecystic fluid are the findings associated with transabdominal [[ultrasound]] in patients with acute cholecystitis. | [[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. Transabdominal [[ultrasonography]] is the '''initial study of choice''' for the diagnosis of acute cholecystitis and [[gallstones]]. [[Gallbladder wall thickening|Thickened gallbladder]], [[gallstones]] or sludge, and pericholecystic fluid are the findings associated with transabdominal [[ultrasound]] in patients with acute cholecystitis. | ||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
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=== Gold standard/Study of choice: === | === Gold standard/Study of choice: === | ||
*[[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. Transabdominal [[ultrasonography]] is the '''initial study of choice''' for the diagnosis of acute cholecystitis and [[gallstones]].<ref name="urlGallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK459171/#article-19448.s5 |title=Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="urlImaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)">{{cite web |url=http://www.ajronline.org/doi/full/10.2214/AJR.10.4340 |title=Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR) |format= |work= |accessdate=}}</ref> | *[[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. Transabdominal [[ultrasonography]] is the '''initial study of choice''' for the diagnosis of acute cholecystitis and [[gallstones]].<ref name="urlGallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK459171/#article-19448.s5 |title=Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="urlImaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)">{{cite web |url=http://www.ajronline.org/doi/full/10.2214/AJR.10.4340 |title=Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR) |format= |work= |accessdate=}}</ref> | ||
* The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis: | ** The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis: | ||
** [[Gallbladder wall thickening|Thickened gallbladder]] (>4 mm) | *** [[Gallbladder wall thickening|Thickened gallbladder]] (>4 mm) | ||
** [[Gallstones]] or sludge | *** [[Gallstones]] or sludge | ||
**Pericholecystic fluid | ***Pericholecystic fluid | ||
* The ultrasound should be performed when: | ** The ultrasound should be performed when: | ||
** The patient presents with [[right upper quadrant pain]], [[abdominal guarding]], [[Abdominal pain and fever|fever]], and a positive [[Murphy's sign]]. | *** The patient presents with [[right upper quadrant pain]], [[abdominal guarding]], [[Abdominal pain and fever|fever]], and a positive [[Murphy's sign]]. | ||
==== The comparison table for diagnostic studies of choice for acute cholecystitis ==== | ==== The comparison table for diagnostic studies of choice for acute cholecystitis ==== | ||
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** The patient presents with [[right upper quadrant pain]], [[abdominal guarding]], [[Abdominal pain and fever|fever]], and a positive [[Murphy's sign]]. | ** The patient presents with [[right upper quadrant pain]], [[abdominal guarding]], [[Abdominal pain and fever|fever]], and a positive [[Murphy's sign]]. | ||
** A positive transabdominal ultrasonography is detected in the patient, to confirm the diagnosis. | ** A positive transabdominal ultrasonography is detected in the patient, to confirm the diagnosis. | ||
*[[Cholescintigraphy]] is the '''gold standard''' | *[[Cholescintigraphy]] is the '''gold standard''' for the diagnosis of acute cholecystitis. [[Cholescintigraphy]] is an alternative method of imaging and uses technetium-labeled [[HIDA scan|hepatic 2,6-dimethyl-iminodiacetic acid]] ([[HIDA scan|HIDA]]) in difficult cases or uncertain diagnosis. | ||
** [[HIDA scan|HIDA]] is injected intravenously and taken up by the liver. [[HIDA scan|HIDA]] is excreted in the bile and therefore, can visualize hepato-biliary tree. | ** [[HIDA scan|HIDA]] is injected intravenously and taken up by the liver. [[HIDA scan|HIDA]] is excreted in the bile and therefore, can visualize hepato-biliary tree. | ||
*Abdominal [[Magnetic resonance imaging|MRI]] and [[CT scan]] can also be used for the diagnosis of acute cholecystitis and it's complications. These modalities are not preferred because: | *Abdominal [[Magnetic resonance imaging|MRI]] and [[CT scan]] can also be used for the diagnosis of acute cholecystitis and it's complications. These modalities are not preferred because: | ||
Latest revision as of 18:36, 8 February 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
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Overview
Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis and 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:
- Cholescintigraphy is the gold standard for the diagnosis of acute cholecystitis. Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis and gallstones.[1][2][3][2][4]
- 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 presents with right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign.
- The following result of transabdominal ultrasonography is confirmatory of acute cholecystitis:
The comparison table for diagnostic studies of choice for acute cholecystitis
The table below summarizes the sensitivities and specificities of the diagnostic studies for acute cholecystitis.[5]
| Test | Sensitivity | Specificity |
|---|---|---|
| Transabdominal Ultrasound✔✔ | 81% | 83% |
| Cholescintigraphy(HIDA)✔ | 96% | 90% |
| MRI | 85% | 81% |
✔= The best test based on the sensitivity and specificity ✔✔=Gold standard
Sequence of Diagnostic Studies
There is no specific sequence of the diagnostic studies for acute cholecystitis. Ultrasound is the initial test performed in the suspected case of acute cholecystitis. Alternative tests are performed in diagnostic uncertainity.[3][2]
- The transabdominal ultrasonography is the initial study of choice and should be performed when:
- The patient presents 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 the gold standard for the diagnosis of acute cholecystitis. Cholescintigraphy is an alternative method of imaging and uses technetium-labeled hepatic 2,6-dimethyl-iminodiacetic acid (HIDA) in difficult cases or uncertain diagnosis.
- Abdominal 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
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The diagnostic criteria for acute cholecystitis is:[6] A. Local signs of inflammation etc.
B. Systemic signs of inflammation etc. C. Imaging findings
Suspected diagnosis: One item in A + one item in B Definite diagnosis: One item in A + one item in B + C
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| Adopted from Journal of Hepato-Biliary-Pancreatic Sciences |
References
- ↑ "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
- ↑ 2.0 2.1 2.2 Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.
- ↑ 3.0 3.1 Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.
- ↑ "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".
- ↑ Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA (2012). "A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis". Radiology. 264 (3): 708–20. doi:10.1148/radiol.12111561. PMID 22798223.
- ↑ Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG (2013). "TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)". J Hepatobiliary Pancreat Sci. 20 (1): 35–46. doi:10.1007/s00534-012-0568-9. PMID 23340953.