Acute Cholecystitis: Investigations
Although laboratory criteria are not reliable in identifying all patients with cholecystitis, the following findings may be useful in arriving at the diagnosis:
|
EtiologyPathophysiologyHistoryPhysical ExaminationInvestigationsDifferential DiagnosisManagementClinical ScenariosAnswers |
- Bilirubin and alkaline phosphatase assays are used to evaluate evidence of common duct obstruction.
- Amylase/lipase assays are used to evaluate the presence of pancreatitis. Amylase may also be elevated mildly in cholecystitis.
- An elevated alkaline phosphatase level is observed in 25% of patients with cholecystitis.
Imaging
Ultrasonography is 90-95% sensitive for cholecystitis and is 78-80% specific. It provides greater than 95% sensitivity and specificity for the diagnosis of gallstones more than 2 mm in diameter.
Ultrasonographic findings that are suggestive of acute cholecystitis include the following: pericholecystic fluid, gallbladder wall thickening greater than 4 mm, and sonographic Murphy sign. The presence of gallstones also helps to confirm the diagnosis.
Click here to view images
The sensitivity and specificity of CT scan and MRI for predicting acute cholecystitis have been reported to be greater than 95%. Spiral CT scan and MRI (unlike endoscopic retrograde cholangiopancreatography [ERCP]) have the advantage of being noninvasive, but they have no therapeutic potential and are most appropriate in cases where stones are unlikely.
Findings suggestive of cholecystitis include wall thickening (>4 mm), pericholecystic fluid, subserosal edema (in the absence of ascites), intramural gas, and sloughed mucosa.
ERCP may be useful for visualizing the anatomy in patients at high risk for gallstones if signs of common bile duct obstruction are present.
Ultrasonography is 90-95% sensitive for cholecystitis and is 78-80% specific. It provides greater than 95% sensitivity and specificity for the diagnosis of gallstones more than 2 mm in diameter.
Ultrasonographic findings that are suggestive of acute cholecystitis include the following: pericholecystic fluid, gallbladder wall thickening greater than 4 mm, and sonographic Murphy sign. The presence of gallstones also helps to confirm the diagnosis.
Click here to view images
The sensitivity and specificity of CT scan and MRI for predicting acute cholecystitis have been reported to be greater than 95%. Spiral CT scan and MRI (unlike endoscopic retrograde cholangiopancreatography [ERCP]) have the advantage of being noninvasive, but they have no therapeutic potential and are most appropriate in cases where stones are unlikely.
Findings suggestive of cholecystitis include wall thickening (>4 mm), pericholecystic fluid, subserosal edema (in the absence of ascites), intramural gas, and sloughed mucosa.
ERCP may be useful for visualizing the anatomy in patients at high risk for gallstones if signs of common bile duct obstruction are present.