Acute cholecystitis diagnostic study of choice

Jump to navigation Jump to search


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

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute cholecystitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Guidelines for Management

Case Studies

Case #1

Acute cholecystitis diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute cholecystitis diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute cholecystitis diagnostic study of choice

CDC on Acute cholecystitis diagnostic study of choice

Acute cholecystitis diagnostic study of choice in the news

Blogs on Acute cholecystitis diagnostic study of choice

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Acute cholecystitis diagnostic study of choice

Overview

Transabdominal ultrasonography is the initial study of choice for the diagnosis of acute cholecystitis. 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:

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.[3][2]

  • The transabdominal ultrasonography should be performed when:
  • Cholescintigraphy (HIDA scan) is the gold standard in the diagnosis of acute cholecystitis. HIDA scan 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 hepato-biliary tree.
  • 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

The diagnostic criteria for acute cholecystitis is:[6]

A. Local signs of inflammation etc.

B. Systemic signs of inflammation etc.

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 Journal of Hepato-Biliary-Pancreatic Sciences

References

  1. "Gallbladder, Cholecystitis, Acute - StatPearls - NCBI Bookshelf".
  2. 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. 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.
  4. "Imaging of Cholecystitis : American Journal of Roentgenology : Vol. 196, No. 4 (AJR)".
  5. 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.
  6. 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.

Template:WH Template:WS