Gallstone disease diagnostic study of choice: Difference between revisions
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{{Gallstone disease}} | {{Gallstone disease}} | ||
==Overview== | ==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 a sensitive modality for detecting gallstones. In obese patients, or patients where imaging is practically difficult an esophageal ultrasound (EUS) with high sensitivity may be used. | Patients who present with [[Right upper quadrant (abdomen)|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 a [[Sensitivity (tests)|sensitive]] modality for detecting gallstones. In [[Obesity|obese]] patients, or patients where imaging is practically difficult an esophageal [[ultrasound]] (EUS) with high [[Sensitivity (tests)|sensitivity]] may be used. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
===Gold standard/Study of choice:=== | ===Gold standard/Study of choice:=== | ||
*Transabdominal ultrasound (TAUS) is the gold standard test for the diagnosis of gallstone disease. | *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: | *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 | **Solitary or multiple stones in the [[gallbladder]] or another site within the [[biliary tree]]. | ||
**Sludge or gravel seen within the gallbladder | **Sludge or gravel seen within the [[Gallbladder|gallbladder.]] | ||
*The transabdominal ultrasound should be performed when: | *The transabdominal [[ultrasound]] should be performed when: | ||
**The patient presented with symptoms/signs abdominal pain, jaundice and fever | **The patient presented with [[Symptom|symptoms]]/[[Medical sign|signs]] of abdominal pain, jaundice and fever. | ||
*Investigations: | *Investigations: | ||
**Among patients who present with clinical signs of gallstone disease, the transabdominal ultrasound is the most specific test for the diagnosis. | **Among patients who present with clinical signs of gallstone disease, the transabdominal ultrasound is the most [[Specificity (tests)|specific]] test for the diagnosis. | ||
**Gallstones appear as echogenic foci that cast an acoustic shadow and exhibit | **Gallstones appear as [[Echogenicity|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. | **Gravel has a similar appearance to stones and are also echogenic and cast shadows. | ||
**Sludge is echogenic but does not cast shadows. | **Sludge is [[Echogenicity|echogenic]] but does not cast [[Acoustic shadow|shadows]]. | ||
==== The comparison table for diagnostic study of choice for gallstone disease<ref name="pmid7979854">{{cite journal |vauthors=Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS |title=Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease |journal=Arch. Intern. Med. |volume=154 |issue=22 |pages=2573–81 |year=1994 |pmid=7979854 |doi= |url=}}</ref> ==== | ==== The comparison table for diagnostic study of choice for gallstone disease<ref name="pmid7979854">{{cite journal |vauthors=Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS |title=Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease |journal=Arch. Intern. Med. |volume=154 |issue=22 |pages=2573–81 |year=1994 |pmid=7979854 |doi= |url=}}</ref> ==== | ||
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=====Diagnostic results===== | =====Diagnostic results===== | ||
The following result of transabdominal ultrasound is confirmatory 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. | *Solitary or multiple stones in the [[gallbladder]] or another site within the [[biliary tree]]. | ||
*Sludge or gravel seen within the gallbladder | *Sludge or gravel seen within the [[gallbladder]]. | ||
=====Sequence of Diagnostic Studies===== | =====Sequence of Diagnostic Studies===== | ||
The transabdominal ultrasound should be performed when: | 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. | *The patient presented with [[Symptom|symptoms]]/[[Medical sign|signs]] of [[Gallstone disease history and symptoms|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. | *A positive result is the visualization of stones detected in the patient, to confirm the diagnosis. | ||
=== Diagnostic Criteria === | === Diagnostic Criteria === | ||
*There is no particular established diagnostic criteria for gallstone disease. | *There is no particular established diagnostic criteria for gallstone disease. | ||
*Diagnosis is based upon history, symptoms and possibly, gallstone detection with transabdominal ultrasound.<ref name="pmid981625">{{cite journal |vauthors=Leopold GR, Amberg J, Gosink BB, Mittelstaedt C |title=Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques |journal=Radiology |volume=121 |issue=2 |pages=445–8 |year=1976 |pmid=981625 |doi=10.1148/121.2.445 |url=}}</ref><ref name="pmid108978">{{cite journal |vauthors=Conrad MR, Janes JO, Dietchy J |title=Significance of low level echoes within the gallbladder |journal=AJR Am J Roentgenol |volume=132 |issue=6 |pages=967–72 |year=1979 |pmid=108978 |doi=10.2214/ajr.132.6.967 |url=}}</ref><ref name="pmid3263025">{{cite journal |vauthors=Brink JA, Simeone JF, Mueller PR, Richter JM, Prien EL, Ferrucci JT |title=Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy |journal=AJR Am J Roentgenol |volume=151 |issue=5 |pages=927–31 |year=1988 |pmid=3263025 |doi=10.2214/ajr.151.5.927 |url=}}</ref><ref name="pmid6769957">{{cite journal |vauthors=Filly RA, Allen B, Minton MJ, Bernhoft R, Way LW |title=In vitro investigation of the origin of echoes with biliary sludge |journal=J Clin Ultrasound |volume=8 |issue=3 |pages=193–200 |year=1980 |pmid=6769957 |doi= |url=}}</ref> | *[[Diagnosis]] is based upon [[Medical history|history]], [[Symptom|symptoms]] and possibly, gallstone detection with transabdominal [[ultrasound]].<ref name="pmid981625">{{cite journal |vauthors=Leopold GR, Amberg J, Gosink BB, Mittelstaedt C |title=Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques |journal=Radiology |volume=121 |issue=2 |pages=445–8 |year=1976 |pmid=981625 |doi=10.1148/121.2.445 |url=}}</ref><ref name="pmid108978">{{cite journal |vauthors=Conrad MR, Janes JO, Dietchy J |title=Significance of low level echoes within the gallbladder |journal=AJR Am J Roentgenol |volume=132 |issue=6 |pages=967–72 |year=1979 |pmid=108978 |doi=10.2214/ajr.132.6.967 |url=}}</ref><ref name="pmid3263025">{{cite journal |vauthors=Brink JA, Simeone JF, Mueller PR, Richter JM, Prien EL, Ferrucci JT |title=Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy |journal=AJR Am J Roentgenol |volume=151 |issue=5 |pages=927–31 |year=1988 |pmid=3263025 |doi=10.2214/ajr.151.5.927 |url=}}</ref><ref name="pmid6769957">{{cite journal |vauthors=Filly RA, Allen B, Minton MJ, Bernhoft R, Way LW |title=In vitro investigation of the origin of echoes with biliary sludge |journal=J Clin Ultrasound |volume=8 |issue=3 |pages=193–200 |year=1980 |pmid=6769957 |doi= |url=}}</ref> | ||
==References== | ==References== | ||
<references /> | <references /> | ||
Revision as of 18:02, 8 December 2017
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 a sensitive modality for detecting gallstones. In obese patients, or patients where imaging is practically difficult an esophageal ultrasound (EUS) with high sensitivity may be used.
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:
- 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.
The comparison table for diagnostic study of choice for gallstone disease[1]
| 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
- There is no particular established diagnostic criteria for gallstone disease.
- Diagnosis is based upon history, symptoms and possibly, gallstone detection with transabdominal ultrasound.[2][3][4][5]
References
- ↑ 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.
- ↑ 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.