Materiały źródłowe

• #1 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/

  Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 710 days from symptom onset. […] After clinical, laboratory, and imaging examination, the diagnosis of AC is relatively straightforward. […] The mainstay of AC diagnosis and treatment has been delineated in recent expert guidelines. […] In the course of AC, concomitant gallstone-related complications may occur, such as choledocholithiasis, acute cholangitis, and biliary pancreatitis. In such cases, additional diagnostic workup and adequate therapeutic procedures must be performed.

• #2 Cholecystitis (Gallbladder Inflammation): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15265-gallbladder-swelling–inflammation-cholecystitis

  Cholecystitis is inflammation in your gallbladder, an organ in your upper right abdomen. […] Acute cholecystitis is usually caused by something blocking the flow of bile. […] A gallstone that obstructs the flow of bile from your gallbladder will cause acute cholecystitis. […] A healthcare provider will start by asking you about your symptoms. If they suspect cholecystitis, they might check for it by asking you to take a deep breath while they gently press on your upper right abdomen. If this is painful, it’s a classic sign of cholecystitis (Murphy’s sign). […] Tests to diagnose cholecystitis may include: Complete blood count (CBC), Liver function tests, Abdominal ultrasound, Endoscopic ultrasound, CT scan (computed tomography scan), HIDA scan (hepatobiliary iminodiacetic acid scan).

• #3 Acute cholecystitis

  https://www.nhs.uk/conditions/acute-cholecystitis/

  Acute cholecystitis is potentially serious because of the risk of complications. […] It’s important for acute cholecystitis to be diagnosed as soon as possible, as there’s a risk of serious complications developing if it’s not treated promptly. […] If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment. […] Tests you may have in hospital include: blood tests to check for signs of inflammation in your body, an ultrasound scan of your tummy to check for gallstones or other signs of a problem with your gallbladder. […] If you’re diagnosed with acute cholecystitis, you’ll probably need to be admitted to hospital for treatment. […] Initial treatment will usually involve: not eating or drinking (fasting) to take the strain off your gallbladder, receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration, taking medicine to relieve your pain. […] A laparoscopic cholecystectomy is often recommended within 1 week of confirming acute cholecystitis. […] Emergency surgery to remove the gallbladder is needed to treat these complications in about 2 or 3 in every 10 cases of acute cholecystitis.

• #4 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/

  The diagnosis of AC is based on clinical presentation, a physical examination, laboratory findings, and an imaging study. […] AC should be suspected in patients presenting with right upper quadrant pain, sometimes accompanied by fever, nausea, and vomiting. […] On physical examination, the presence of a positive Murphy sign (arrest of inspiration during palpation of the right upper quadrant) is very suggestive of AC, with a specificity of 87% to 97%. […] In the course of AC, the main laboratory findings are leukocytosis and increased C-reactive protein. […] Ultrasound (US) is the most employed imaging technique for the initial diagnosis of AC. […] The cornerstone of AC treatment is ELC. In particular, ELC performed within 72 h should be the method of choice for the treatment of AC, because it is related to a shorter hospital stay, fewer perioperative complications, and reduced costs.

• #5 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://www.mdpi.com/2077-0383/13/9/2695

  The diagnosis of AC is based on clinical presentation, a physical examination, laboratory findings, and an imaging study. […] AC should be suspected in patients presenting with right upper quadrant pain, sometimes accompanied by fever, nausea, and vomiting. […] On physical examination, the presence of a positive Murphy sign (arrest of inspiration during palpation of the right upper quadrant) is very suggestive of AC, with a specificity of 87% to 97%. […] In the course of AC, the main laboratory findings are leukocytosis and increased C-reactive protein. […] Ultrasound (US) is the most employed imaging technique for the initial diagnosis of AC. […] Thickening of the gallbladder wall (>3 mm) with a layered appearance, gallstones or retained debris, pericholecystic fluid, and gallbladder enlargement are the typical sonographic signs of AC.

• #6 Acute cholecystitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000084

  Acute cholecystitis is a major complication of cholelithiasis (i.e., gallstones); symptomatic gallstones are common before developing cholecystitis. […] Patients typically present with pain and localised tenderness, with or without guarding, in the upper right quadrant. […] There may be evidence of a systemic inflammatory response with fever, elevated white cell count, and raised C-reactive protein. […] Ultrasound is the definitive initial test. Magnetic resonance cholangiopancreatography may be required. In a patient with suspected sepsis, use computed tomography (or magnetic resonance imaging) to identify the cause. […] Diagnostic investigations include CT or MRI of the abdomen, abdominal ultrasound, FBC, CRP, bilirubin, LFTs, serum lipase or amylase, and blood cultures and/or bile cultures. […] Investigations to consider include magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS).

• #7 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2784516/

  The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. […] Patients exhibiting one of the local signs of inflammation, such as Murphys sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. […] The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). […] Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure.

• #8 Diagnosing Biliary Colic and Acute Cholecystitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0915/p1386.html

  Pain in the area of the gall bladder lasting more than three hours is characteristic of acute cholecystitis. The most common cause is cystic duct obstruction by gallstone(s), and the initial symptom may be epigastric pain. A pain-free interval may occur before symptoms shift to the right upper quadrant. Older patients may have only localized tenderness. As local inflammation becomes more intense, signs and symptoms of tenderness and a local mass can be complicated by systemic toxicity manifested by fever and leukocytosis. The classic Murphy’s sign (abrupt interruption of deep inspiration) is elicited by palpation of the gallbladder area. A palpable mass caused by inflammation and adherent omentum is present in 30 to 40 percent of patients with cholecystitis. Abdominal guarding in response to deep palpation is common. Up to 15 percent of patients with acute cholecystitis are jaundiced.

• #9 Acute Cholecystitis – Core EM

  https://coreem.net/core/acute-cholecystitis/

  Acute cholecystitis is an inflammation of the gallbladder that is most readily diagnosed by US. […] Diagnostic Test Performance in Acute Cholecystitis (The Resus Room) […] Overall, laboratory tests are insensitive and non-specific. They can neither rule in nor out the disease. […] Ultrasound (US) is the best test for diagnosis of acute cholecystitis. […] Common findings include the presence of gallstones, thickened gallbladder wall, pericholecystic fluid, and maximal tenderness elicited over the visualized gallbladder by the US probe. […] CT has higher accuracy than US for defining complications related to cholecystitis. […] Nuclear Scintigraphy with Technetium-99m-labeled hepatobiliary iminodiacetic acid (HIDA) is the gold standard for diagnosis with high sensitivity and specificity.

• #10

  https://journals.lww.com/ajg/fulltext/2024/10001/s2658_pictures_aren_t_always_worth_a_thousand.2659.aspx

  The diagnosis of acute cholecystitis relies on clinical presentation, laboratory testing, and imaging. However, approximately 19% of cases present with negative or equivocal imaging findings. Hence, undue dependence on diagnostic imaging may lead to missed or delayed diagnosis. […] Diagnosing acute cholecystitis begins with clinical suspicion based on RUQ abdominal pain, Murphy’s sign, and systemic inflammation, which includes fever and leukocytosis. While US typically confirms the diagnosis, it yields negative or equivocal results in 19% of cases. In our case, despite equivocal imaging findings, acute cholecystitis remained the primary diagnosis, ultimately leading to laparoscopic cholecystectomy with diagnostic confirmation via surgical pathology. In summary, it is crucial for physicians to consider acute cholecystitis in those presenting with RUQ abdominal pain and equivocal imaging, as delayed surgical intervention can lead to longer hospital stays, greater surgical complications, and increased mortality.

• #11 Diagnosing Biliary Colic and Acute Cholecystitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0915/p1386.html

  Laboratory results are usually normal in patients with biliary colic. Leukocytosis with bandemia is a frequent finding in patients with acute cholecystitis, and mild elevations of serum aminotransferase levels may occur within a few hours of onset. […] In patients with acute cholecystitis, prompt surgery is recommended.

• #12 Cholecystitis – Liver and Gallbladder Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/liver-and-gallbladder-disorders/gallbladder-and-bile-duct-disorders/cholecystitis

  Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdomen. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken. […] Doctors diagnose cholecystitis based mainly on symptoms and results of imaging tests. […] Ultrasonography is the best way to detect gallstones in the gallbladder. Ultrasonography can also detect fluid around the gallbladder or thickening of its wall, which are typical of acute cholecystitis. […] Cholescintigraphy, another imaging test, is useful when acute cholecystitis is difficult to diagnose. […] A high white blood cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder. […] Computed tomography (CT) of the abdomen can detect some complications of cholecystitis, such as pancreatitis or a tear in the gallbladder.

• #13 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2784516/

  Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. […] Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction. […] Specific diagnostic criteria are necessary to accurately diagnose typical, as well as atypical cases. […] Diagnosis of acute cholecystitis by elevation of CRP level (3 mg/dl or more), with ultrasonographic findings suggesting acute cholecystitis, has a sensitivity of 97%, specificity of 76%, and positive predictive value of 95%. […] The clinical diagnosis of acute cholecystitis is traditionally based on the patients clinical presentation, and it is confirmed by the imaging findings. […] The criteria for moderate (grade II) acute cholecystitis can be defined as acute cholecystitis associated with local inflammatory conditions that make cholecystectomy difficult.

• #14 Cholecystitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895

  To diagnose cholecystitis, your healthcare professional does a physical exam and asks about your symptoms and medical history. Tests and procedures used to diagnose cholecystitis include: […] Blood tests can look for signs of an infection or other gallbladder issues. […] Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, CT scan or magnetic resonance cholangiopancreatography can make pictures of your gallbladder and bile ducts. These pictures may show signs of cholecystitis or stones in the bile ducts and gallbladder. […] A hepatobiliary iminodiacetic acid (HIDA) scan tracks the making and flow of bile from the liver to the small intestine. A HIDA scan involves putting a radioactive dye into your body. The dye attaches to the cells that make bile. During the scan, the dye can be seen as it travels with the bile through the bile ducts. This can show any blockages.

• #15 Acute Cholecystitis Workup: Approach Considerations, Laboratory Tests, Radiography

  https://emedicine.medscape.com/article/171886-workup

  The workup for cholecystitis includes history and physical examination, laboratory tests (though these are not always reliable), plain x-ray of the abdomen, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), hepatobiliary isotope scintigraphy (HBS), and endoscopy. […] Ultrasonography is the preferred initial imaging test for the diagnosis of acute cholecystitis; scintigraphy is the preferred alternative. […] CT scanning is a secondary imaging test that can identify complications of acute cholecystitis and extrabiliary disorders when ultrasonography has not yielded a clear diagnosis. […] The sensitivity and specificity of computed tomography (CT) scanning and magnetic resonance imaging (MRI) in predicting acute cholecystitis have been reported to be greater than 95%. […] Hepatobiliary isotope scintigraphy (HBS) has been found to be up to 95% accurate in diagnosing acute cholecystitis.

• #16 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x

  1.1 As no feature has sufficient diagnostic power to establish or exclude the diagnosis of ACC, it is recommended not to rely on a single clinical or laboratory finding. […] 1.2 For the diagnosis of ACC, we suggest using a combination of detailed history, complete clinical examination, laboratory tests and imaging investigations. However, the best combination is not known. […] The recommendations of the 2016 WSES guidelines were mainly based on two studies: a systematic review and meta-analysis by Trowbridge et al. and a prospective diagnostic study by Eskelinen et al. […] The TG criteria for the diagnosis of cholecystitis include clinical signs, laboratory tests and imaging features. […] 1.3 We recommend the use of abdominal ultrasound (US) as the preferred initial imaging technique, in view of its cost-effectiveness, wide availability, reduced invasiveness and good accuracy for gallstones disease.

• #17 Diagnosis of Acute Cholecystitis | CDA-AMC

  https://www.cda-amc.ca/diagnosis-acute-cholecystitis

  CT findings consistent with acute cholecystitis include gallbladder wall thickening, gallbladder distention, pericholecystic fluid, and pericholecystic fat. […] MRCP findings indicative of acute cholecystitis include gallbladder stones, wall thickening, and pericholecystic fluid. […] U/S findings consistent with acute cholecystitis include the visualization of gallstones, intraluminal sludge, thickening of the gallbladder wall, pericholecystic fluid, increased blood flow in the gallbladder wall, and sonographic Murphy’s sign. […] If a test for diagnosing acute cholecystitis is not available, treatment might be delayed and complications associated with high mortality rates might be more likely to develop. Complications from acute cholecystitis occur in around 20% of patients and complicated acute cholecystitis is associated with a mortality rate of around 25%.

• #18 Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/2036-7902-5-S1-S11

  A positive Murphys sign (pain is provoked by either the transducer or the sonographers palpation under guidance, in the exact area of the gallbladder) is reported to have sensitivity as high as 88%. […] An increased gallbladder wall thickness of 3.5 mm has been found to be a reliable and independent predictor of acute cholecystitis. […] Visualization of gallbladder wall thickening in the presence of gallstones using ultrasound has a positive predictive value of 95% for the diagnosis of acute cholecystitis. […] Cholescintigraphy still has the highest sensitivity and specificity (96% and 90%) in patients who are suspected of having acute cholecystitis. […] CT is particularly useful for evaluating the many complications of acute cholecystitis, such as emphysematous cholecystitis, gangrenous cholecystitis, hemorrhage, and gallstone ileus. […] In current practice, in the emergency setting, CT is being used increasingly especially in elderly patients with abdominal pain even when they are suspected of having acute cholecystitis.

• #19 Diagnosis of Acute Cholecystitis | CDA-AMC

  https://www.cda-amc.ca/diagnosis-acute-cholecystitis

  Diagnostic imaging test results can have minimal impact on mortality. […] If a test for diagnosing acute cholecystitis is not available, treatment might be delayed and patients may have to suffer symptoms of acute cholecystitis longer than necessary. Delayed treatment will make patients more susceptible to complications that could increase the global hospitalization length and have an impact on their survival or quality of life. […] Cholescintigraphy Patients may have concerns about radiation exposure and the intravenous injection of a radiopharmaceutical agent. […] The authors estimated sensitivity and specificity of cholescintigraphy to be 0.97 (confidence interval [CI], 0.96 to 0.99) and 0.90 (0.86 to 0.95), respectively. […] The authors estimated verification bias adjusted sensitivity and specificity of U/S to be 0.88 (0.74 to 1.00) and 0.80 (0.62 to 0.98), respectively. […] The authors estimated the sensitivity of cholescintigraphy to be 90.9%.

• #20 Clinical Value of Sonography and CT-Scan in the Diagnosis of Acute Cholecystitis: A Retrospective Analysis

  https://www.jscimedcentral.com/jounal-article-info/Annals-of-Emergency-Surgery/Clinical-Value-of-Sonography-and-CT-Scan-in-the-Diagnosis-of-Acute-Cholecystitis:-A-Retrospective-Analysis-2968

  Only in case of unclear clinical symptoms or discrepant findings a further radiological examination by computed tomography should be done. […] Our study showed that computed tomography yielded a specificity of 85.7% and a sensitivity of 90.3% with an overall accuracy of 90.1%. Sonography had a specificity of 95.6% and a sensitivity of 74.7% with an overall accuracy of 77.0% in our retrospective analysis. […] We recommend ultrasound as a first choice for acute right upper abdominal pain with suspected history of gall stone disease. If the findings are unclear, computed tomography provides a useful supplement radiological examination with a high overall accurance in diagnosis of acute cholecystitis.

• #21 Acute cholecystitis diagnostic study of choice – wikidoc

  https://www.wikidoc.org/index.php/Acute_cholecystitis_diagnostic_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. Thickened gallbladder, gallstones or sludge, and pericholecystic fluid are the findings associated with transabdominal ultrasound in patients with acute cholecystitis. […] 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.

• #22 Diagnosis of Acute Cholecystitis | CDA-AMC

  https://www.cda-amc.ca/diagnosis-acute-cholecystitis

  If there is no cystic duct blockage, the radiopharmaceutical will enter the gallbladder, which will be visualized in images created by the gamma camera. If a gallstone is obstructing a patient’s cystic duct, the radiopharmaceutical will not enter the gallbladder and visualization of the gallbladder cannot occur. Non-visualization of the gallbladder is indicative of acute cholecystitis. […] This delayed imaging increases the specificity of cholescintigraphy for the diagnosis of acute cholecystitis. […] An alternative to delayed imaging is to inject the patient with a small amount of morphine sulphate (0.02 mcg/kg). Administration of morphine sulphate facilitates the flow of bile toward the cystic duct by causing contraction of the sphincter of Oddi. The injection of morphine sulphate can reduce the time to confirm the diagnosis from three or four hours to 1.5 hours.

• #23 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://www.mdpi.com/2077-0383/13/9/2695

  Second-level imaging techniques (CT and MRI) are indicated in case of a doubtful diagnosis or to confirm suspected complications of AC. […] Hepatobiliary scintigraphy (HIDA scan) is the most sensitive and specific test for AC, which is associated with the absence of radiotracer uptake in the gallbladder before and after morphine administration.

• #24 Acute Cholecystitis: Comparison of Clinical Findings from Ultrasound and Computed Tomography

  https://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-7-079.php?jid=jcgt

  Acute cholecystitis is a common surgical emergency, for which ultrasound (US) is the most common first-line diagnostic imaging test. Computed tomography (CT) is an alternative or complementary test for the assessment of acute cholecystitis. Acute cholecystitis is diagnosed based on clinical history and assessment, biochemical examination, and US findings. CT is considered only in case of unclear clinical symptoms or discrepant findings. […] The diagnosis of acute cholecystitis is confirmed on the basis of typical anamnesis, including recurrent or unrelenting right-upper quadrant pain, fever, nausea, and clinical examination findings of right-upper quadrant tenderness, positive Murphy sign, elevated laboratory findings for acute inflammation, and ultrasound (US). Only in the case of unclear clinical symptoms or discrepant findings, a further radiological examination is conducted by computed tomography (CT).

• #25 Cholecystitis (Gallbladder inflammation), Diagnosis & Treatment

  https://www.radiologyinfo.org/en/info/cholecystitis

  Magnetic resonance cholangiopancreatography (MRCP): MRCP is a type of MRI exam that makes detailed images of the liver, gallbladder, bile ducts, pancreas and pancreatic duct. It is very good at showing gallstones, gallbladder or bile duct inflammation, and blocked bile flow. […] Hepatobiliary nuclear imaging: This nuclear medicine test uses an injected radiotracer to help evaluate disorders of the liver, gallbladder and bile duct (biliary system). In acute cholecystitis, it can detect blockage of the cystic duct (the duct that is always blocked with acute cholecystitis).

• #26 Acute cholecystitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-cholecystitis?lang=us

  Acute cholecystitis refers to the acute inflammation of the gallbladder. It is the primary complication of cholelithiasis and the most common cause of acute pain in the right upper quadrant (RUQ). […] Ultrasound (US) is the preferred initial modality in the investigation of right upper quadrant pain. It is more sensitive than HIDA scintigraphy and more readily available. […] The most sensitive US finding in acute cholecystitis is the presence of cholelithiasis in combination with the sonographic Murphy sign. […] HIDA cholescintigraphy in acute cholecystitis will demonstrate non-visualization of the gallbladder 4 hours after injection. […] Although traditionally considered less sensitive than ultrasound, some reviews find CT more sensitive for this diagnosis. […] Diagnostic criteria on CT as proposed by Mirvis et al. include major criteria: gallstones, thickened gallbladder wall, pericholecystic fluid collections, subserosal edema. […] MRI is sensitive in the detection of acute cholecystitis, with findings similar to those seen on ultrasound and CT.

• #27 MR Cholangiography for Diagnosing Acute Cholecystitis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0215/p1022.html

  Ultrasonography has been the screening test of choice for use in the diagnosis of acute cholecystitis. […] Although ultrasonography is an effective and easily accessible diagnostic modality, it can depict calculi only in the gall-bladder and not in the cystic duct. […] For this reason, other signs, such as gallbladder wall thickness, fluid collection and enlargement of the gallbladder, have been used to aid diagnosis. […] Magnetic resonance (MR) cholangiography has proved accurate in the diagnosis of bile duct obstruction and choledocholithiasis. […] Ultrasonography depicted only one of the seven cystic duct calculi (14 percent), but MR cholangiography depicted all of the calculi. […] On a patient-for-patient basis, ultrasonography demonstrated a sensitivity of 62 percent in the diagnosis of cystic duct obstruction, a specificity of 100 percent and an accuracy of 77 percent. MR cholangiography demonstrated a sensitivity of 100 percent, a specificity of 93 percent and an accuracy of 97 percent.

• #28 Acute cholecystitis diagnostic study of choice – wikidoc

  https://www.wikidoc.org/index.php/Acute_cholecystitis_diagnostic_study_of_choice

  The diagnostic criteria for acute cholecystitis is: A. Local signs of inflammation etc. Murphy’s sign, RUQ mass/pain/tenderness. B. Systemic signs of inflammation etc. Fever, Elevated CRP, Elevated WBC count. C. 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.

• #29 ACUTE CHOLECYSTITIS-diagnosis – The Secrets Of Medicine

  https://www.thesecretsofmedicine.com/acute-cholecystitis-diagnosis/

  According to the TG 2013, local signs, systemic signs and imaging findings comprise the main parameters for the diagnosis of AC. The sensitivity and specificity of TG13 for the diagnosis of AC were 91.2 and 96.9%, respectively. The diagnostic criteria for TG13 remained unchanged for TG18. […] The diagnostic criteria for acute cholecystitis according to the Tokyo Guidelines (TG) 2018 are categorized into clinical findings, imaging findings, and laboratory data. Here are the detailed criteria: […] To diagnose acute cholecystitis according to TG 2018: […] 1A + 1B = suspected acute cholecystitis […] At least 1A + 1B + 1C = the diagnosis of acute cholecystitis confirmed. […] When AC is suspected in a patient, we try to make a definitive diagnosis based on the diagnostic criteria, evaluate the severity of the disease using severity rating criteria, and evaluate the surgical risks.

• #30 Classification Schemes for Acute Cholecystitis

  https://www.pajtcces.com/abstractArticleContentBrowse/PAJT/31332/JPJ/fullText

  The assessment of the severity of cholecystitis by the Tokyo scale is separated into mild, moderate, and severe. The lowest severity is defined as mild (grade I) acute cholecystitis. This is simply an acute cholecystitis that does not meet the criteria for moderate or severe cholecystitis or acute cholecystitis in an otherwise healthy patient. Moderate (grade II) acute cholecystitis is defined by having any one of the following conditions: elevated WBC, palpable tender mass in the RUQ, duration of complaints for greater than 72 hours, and marked local inflammation (biliary peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, or emphysematous cholecystitis). Severe (grade III) acute cholecystitis is acute cholecystitis with accompanying organ dysfunction (cardiovascular, neurological, respiratory, renal, hepatic, or hematologic).

• #31 The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11084823/

  The quality of the evidence for this statement is considered to be moderate, and the strength of recommendation is strong. […] In patients with mild AC but with a concomitant high surgical risk, ELC can be performed once the medical treatment has improved the patients general condition. […] In contrast, in patients with moderate AC, ELC must be preceded by medical therapy because of the possible surgical challenges related to the inflammatory reaction. […] In cases of severe AC, ELC should be performed only with the availability of intensive care support and in patients with factors that are predictive of clinical recovery. […] The recurrence of AC represents a relatively frequent clinical scenario, accounting for almost one-quarter of patients treated conservatively during the first episode of AC.

• #32 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x

  1.4 We suggest the use of further imaging for the diagnosis of ACC in selected patients, depending on local expertise and availability. Hepatobiliary iminodiacetic acid (HIDA) scan has the highest sensitivity and specificity for the diagnosis of ACC as compared to other imaging modalities. Diagnostic accuracy of computed tomography (CT) is poor. Magnetic resonance imaging (MRI) is as accurate as abdominal US. […] 2.1 We recommend against the use of elevated LFTs or bilirubin as the only method to identify CBDS in patients with ACC, in which case we recommend performing further diagnostic tests. […] 2.2 We suggest considering the visualization of a stone in the common bile duct at transabdominal US as a predictor of CBDS in patients with ACC. […] 2.3 An increased diameter of common bile duct, an indirect sign of stone presence, is not sufficient to identify ACC patients with CBDS and we therefore recommend performing further diagnostic tests.

• #33 Acalculous cholecystitis – EMCrit Project

  https://emcrit.org/ibcc/acalculous-cholecystitis/

  Acalculous cholecystitis is defined as cholecystitis that occurs without a gallstone. […] Acalculous cholecystitis often goes unrecognized initially, because of intubation and sedation. This can lead to a high rate of progression to gallbladder necrosis (50%) and perforation (10%). […] Acalculous cholecystitis is seen mostly in the intensive care unit as a complication of pre-existing critical illness. […] This may account for ~5% of cholecystitis. However, the precise incidence is murky given lack of definitive diagnostic criteria. […] In most cases, this is a clinical diagnosis which is based upon weighing roughly three factors: (a) How persuasive is the evidence of acalculous cholecystitis? (b) How sick is the patient? (c) Are there alternative infectious sources? […] Acalculous cholecystitis should be considered in any critically ill patient with right upper quadrant abdominal pain, persistent fever, sepsis, or jaundice which is otherwise unexplained.

• #34 Acute acalculous cholecystitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-acalculous-cholecystitis?lang=us

  Acute acalculous cholecystitis refers to the development of cholecystitis in the gallbladder either without gallstones or with gallstones where they are not the contributory factor. It is thought to occur most often due to biliary stasis and/or gallbladder ischemia. […] Acute acalculous cholecystitis represents 5-10% of cases of acute cholecystitis. […] Acute acalculous cholecystitis usually occurs in critically ill or injured patients (e.g. trauma, burns, sepsis). The risk factors listed above may affect the perfusion of the gallbladder and favor bile stasis leading to injury and inflammation. […] Generally, ultrasound is needed to confidently exclude the presence of gallstones. […] Tc-99m iminodiacetic acid cholescintigraphy is considered a highly reliable test and may be performed even in acutely ill patients. Ideally, there is non-visualization of the gallbladder.

• #35 Acute cholecystitis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Acute_cholecystitis_differential_diagnosis

  Acute cholecystitis must be differentiated from other diseases that cause right upper quadrant abdominal pain and nausea/vomiting such as biliary colic, acute cholangitis, viral hepatitis, alcoholic hepatitis, acute pancreatitis, acute appendicitis, and irritable bowel syndrome. […] Acute cholecystitis must be differentiated from other diseases that cause right upper quadrant pain and nausea/vomiting such as: […] Ultrasound shows: […] Ultrasound shows gallstone […] Ultrasound shows evidence of inflammation […] The risk of cholangiocarcinoma in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population. […] Ultrasound shows biliary dilatation/stents/tumor […] Ultrasound shows evidence of cirrhosis […] CT scan shows severity of pancreatitis […] CT scan shows: […] CT scan shows evidence of inflammation […] CT scan shows suggestive of Budd-Chiari syndrome include: […] US […] CT

• #36 Cholecystitis Symptoms, Tests, and Treatment | ACE Specialist Clinic

  https://acesurgery.sg/24-7-emergency/acute-cholecystitis/

  Acute cholecystitis is diagnosed through a combination of clinical assessment and diagnostic tests: […] Doctors conduct a thorough physical examination, focusing on symptoms such as abdominal pain, tenderness, and fever. In particular, our surgeon will examine the upper right abdomen for the Murphy’s Sign (the patient abruptly stops breathing in response to pressure). […] Laboratory tests, including complete blood count (CBC), liver function tests (LFTs), C-reactive protein (CRP), and serum bilirubin, can help assess inflammation and liver function. […] The primary imaging modality used to visualise gallstones, gallbladder wall thickening, and pericholecystic fluid, which are characteristic findings of acute cholecystitis. […] If not treated immediately, acute cholecystitis can be a life-threatening medical emergency that often results in serious complications, such as rupture of the gallbladder (walls of the gallbladder burst or leak), pancreatitis (inflammation of the pancreas) and gangrene (cell death) of the gallbladder. […] Patients with acute cholecystitis should seek urgent medical attention as soon as possible to prevent complications.

• #37 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x

  3.1 We recommend laparoscopic cholecystectomy as the first-line treatment for patients with ACC. […] 3.2 We recommend avoiding laparoscopic cholecystectomy in case of septic shock or absolute anaesthesiology contraindications. […] 4.1 In the presence of adequate surgical expertise, we recommend ELC be performed as soon as possible, within 7 days from hospital admission and within 10 days from the onset of symptoms. […] 5.1 We cannot suggest the use of any prognostic model in patients with ACC. […] 6.1 We suggest considering NOM, i.e. best medical therapy with antibiotics and observation, for patients refusing surgery or those who are not suitable for surgery. […] 6.3 Immediate laparoscopic cholecystectomy is superior to percutaneous transhepatic gallbladder drainage (PTGBD) in high risk patients with ACC. We recommend laparoscopic cholecystectomy as the first-choice treatment in this group of patients.

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