Materiały źródłowe

• #1 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. […] Cholecystitis is inflammation in your gallbladder, the small, pear-shaped organ that stores bile. […] Cholecystitis (KO-leh-sis-TY-tiss) is inflammation in your gallbladder, the small, pear-shaped organ that lives under your liver and stores the bile your liver makes. […] Healthcare providers use acalculous to distinguish cholecystitis thats not related to gallstones. […] About 15% of the worlds population has gallstones, and about 20% of these will have complications from gallstones, which include cholecystitis. […] Gallstones blocking your bile ducts are the most common cause of cholecystitis, both chronic and acute. […] A gallstone that obstructs the flow of bile from your gallbladder will cause acute cholecystitis.

• #2 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.

• #3 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%. […] The overall usefulness of procalcitonin for the diagnosis of sepsis has been debated. […] 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.

• #4 Acute Cholecystitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459171/

  Acute cholecystitis is inflammation of the gallbladder that occurs due to occlusion of the cystic duct or impaired emptying of the gallbladder. […] This activity reviews the evaluation and management of acute cholecystitis and reviews the role of the interprofessional team in caring for patients with this condition. […] Acute cholecystitis refers to inflammation of the gallbladder. The pathophysiologic mechanism of acute cholecystitis is blockage of the cystic duct. […] A physical exam with a comprehensive history is paramount in making the diagnosis of cholecystitis. […] A complete blood count (CBC) and a comprehensive metabolic panel are also important. […] In acute cholecystitis or severe disease, white blood cell count (WBC) may be elevated. […] A gallbladder ultrasound is the best test to evaluate gallbladder disease initially.

• #5 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%. […] The overall usefulness of procalcitonin for the diagnosis of sepsis has been debated. […] 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 – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-cholecystitis/

  Acute cholecystitis refers to the acute inflammation of the gallbladder, which is typically due to cystic duct obstruction by a gallstone (acute calculous cholecystitis). Acalculous cholecystitis is less common and is seen predominantly in critically ill patients. RUQ ultrasound is the preferred initial imaging modality, which would show gallbladder distension, edema, and pericholecystic fluid. Empiric antibiotic therapy and laparoscopic cholecystectomy are the mainstays of treatment. […] The diagnosis of acute cholecystitis is based on characteristic clinical features, systemic signs of inflammation (leukocytosis, CRP),; and evidence of gallbladder inflammation on imaging. […] If ultrasound findings are inconclusive, consider abdominal CT scan, abdominal MRI, MRCP, or HIDA scan to confirm the diagnosis.

• #7 Diagnosing Biliary Colic and Acute Cholecystitis | AAFP

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

  Approximately 500,000 cholecystectomies are performed annually in the United States. Symptomatic gallstones are the most common indication for cholecystectomy. A review by Ahmad and colleagues stressed the importance of differentiating biliary colic and acute cholecystitis. Overlapping symptoms may result in misinterpretation. […] 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.

• #8 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.

• #9

  https://step2.medbullets.com/gastrointestinal/120163/acute-cholecystitis

  A 40-year-old obese woman presents to the emergency room for pain in her right upper quadrant of her abdomen. She reports that she has had similar pain on and off for the past few weeks, but this time the pain has persisted for over an hour. She also reports nausea, vomiting, and loss of appetite. On physical exam, she has right upper quadrant pain and inspiratory arrest with deep palpation of the area. An ultrasound of that area reveals distended gallbladder with thickened gallbladder wall and gallstones. She is admitted for further management and the general surgery team is consulted for possible surgery within the next 72 hours. […] Clinical definition: acute inflammation of the gallbladder, often in the setting of gallstones or biliary sludge. […] Pathogenesis: blockage of cystic duct by gallstones can lead to distention of gallbladder, inflammation, and infection. […] Diagnostic criteria: local inflammation (Murphy sign, right upper quadrant tenderness), systemic inflammation (fever, white blood cell count), imaging (cholecystitis).

• #10 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.

• #11 Cholecystitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cholecystitis.html

  Cholecystitis can happen suddenly (acute) or it can be long-term (chronic). […] How is cholecystitis diagnosed? […] Your healthcare provider will look at your past health and give you a physical exam. […] You may also have some blood tests, including: […] Complete blood count. This test measures your white blood cell count. You may have a high white blood cell count if you have an infection. […] Liver function tests. This group of special blood tests can tell if your liver is working correctly. […] You may also have imaging tests, including: […] Ultrasound (sonogram). This test creates images of your internal organs on a computer screen using high-frequency sound waves. It is used to see the liver and gallbladder and check blood flow through different vessels. […] Belly (abdominal) X-ray. This test makes pictures of internal tissues, bones, and organs using X-rays.

• #12 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.

• #13 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.

• #14 Cholecystitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cholecystitis.html

  Cholecystitis can happen suddenly (acute) or it can be long-term (chronic). […] How is cholecystitis diagnosed? […] Your healthcare provider will look at your past health and give you a physical exam. […] You may also have some blood tests, including: […] Complete blood count. This test measures your white blood cell count. You may have a high white blood cell count if you have an infection. […] Liver function tests. This group of special blood tests can tell if your liver is working correctly. […] You may also have imaging tests, including: […] Ultrasound (sonogram). This test creates images of your internal organs on a computer screen using high-frequency sound waves. It is used to see the liver and gallbladder and check blood flow through different vessels. […] Belly (abdominal) X-ray. This test makes pictures of internal tissues, bones, and organs using X-rays.

• #15 Cholecystitis – what is it, causes, symptoms, diagnosis and treatment in Moscow

  https://www.k31.ru/en/service/gastroenterologiya/cholecystitis.html

  To establish an accurate diagnosis, the doctor first talks with the patient and collects an anamnesis. […] The next step is palpation of the abdominal wall, which allows you to identify pain when you press on certain areas. The symptoms of Murphy, Mussy and Chauffard indicate inflammation of the gallbladder. […] After examination and conversation, the doctor prescribes laboratory tests. A general blood test allows you to detect: […] A biochemical blood test is carried out to detect increased activity of liver enzymes – ALaT, ASAT, GGTP and alkaline phosphatase. […] Also, in order to obtain more detailed information about the state of the biliary tract, it is necessary to undergo a series of instrumental studies. Among them: […] Ultrasound of the abdominal cavity – allows you to determine the size of the gallbladder, the thickness of its walls, the presence or absence of deformities and stones, and also check the condition of the bile ducts. […] Cholecystography and cholangiography are x-ray studies using contrast that allow you to evaluate the shape, size and position of the gallbladder, its ability to concentrate and secrete bile.

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

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

  1st investigations to order 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).

• #17 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) […] Common findings include the presence of gallstones (absence of stones has a high negative predictive value for cholecystitis), thickened gallbladder wall (3 mm), pericholecystic fluid, and maximal tenderness elicited over the visualized gallbladder by the US probe (Sonographic Murphys sign). […] Test characteristics: Impacted gallstones (in the neck or cystic duct) + sonographic Murphys sign have a positive predictive value of 70% (Rosen 2001) to 92% (Ralls 1985). Overall sensitivity 88%, specificity 80% (Shea 1994).

• #18 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.

• #19 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%. […] The overall usefulness of procalcitonin for the diagnosis of sepsis has been debated. […] 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.

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

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

  Your doctor may use abdominal ultrasound, abdominal CT, magnetic resonance cholangiopancreatography (MRCP) or nuclear imaging to help diagnose your condition. […] Your doctor may order blood tests to see if you have a gallbladder infection. Often, the white blood cell count in our blood may become elevated as a sign of the infection. One or more of the following radiology tests also may be done: […] Abdominal ultrasound: This is often the first test done to evaluate for cholecystitis. Ultrasound uses sound waves to produce pictures of the gallbladder and the bile ducts. It is used to identify signs of inflammation involving the gallbladder and is very good at showing gallstones. […] Abdominal CT: Computed tomography (CT) uses x-rays to produce detailed pictures of the abdomen, liver, gallbladder, bile ducts and intestine to help identify inflammation of the gallbladder or blocked bile flow.

• #21 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. […] MRI is sensitive in the detection of acute cholecystitis, with findings similar to those seen on ultrasound and CT. […] Diagnosis of acute cholecystitis can be supported if one major and two minor criteria are present.

• #22 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.

• #23 Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00524-5

  An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC. […] US had a pooled sensitivity of 71% (95% CI, 6972%), a specificity of 85% (95% CI, 8486%), and an accuracy of 0.83 (95% CI, 0.820.83) for the diagnosis of AC. […] US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. […] Our results revealed US had a sensitivity of 71%, a specificity of 85%, and an accuracy of 0.83, indicative of good discriminability. […] The presence of gallstones exhibited optimal performance for the diagnosis of AC. However, most of the included studies used the combination of the presence of gallstones with at least one additional inflammatory sign such as GB wall thickness, peri-GB fluid, and sonographic Murphy sign.

• #24 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) […] Common findings include the presence of gallstones (absence of stones has a high negative predictive value for cholecystitis), thickened gallbladder wall (3 mm), pericholecystic fluid, and maximal tenderness elicited over the visualized gallbladder by the US probe (Sonographic Murphys sign). […] Test characteristics: Impacted gallstones (in the neck or cystic duct) + sonographic Murphys sign have a positive predictive value of 70% (Rosen 2001) to 92% (Ralls 1985). Overall sensitivity 88%, specificity 80% (Shea 1994).

• #25 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.

• #26 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.

• #27 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.

• #28 Acute Cholecystitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459171/

  In cases of acute cholecystitis, a hepatobiliary (HIDA) scan is recommended. […] The most appropriate management of cholecystitis is laparoscopic cholecystectomy. […] The preferred recommended treatment is the removal of the gallbladder. […] For patients with uncomplicated acute cholecystitis, the prognosis is excellent. […] The mortality rates are very low. […] Patients with acalculous cholecystitis have high mortality varying from 20-50%.

• #29 Diagnosis of Acute Cholecystitis | CDA-AMC

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

  The authors estimated sensitivity and specificity of cholescintigraphy to be 0.97 and 0.90, respectively. […] The authors estimated verification bias adjusted sensitivity and specificity of U/S to be 0.88 and 0.80, respectively. […] The authors estimated the sensitivity of cholescintigraphy to be 90.9%.

• #30 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.

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

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

  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. […] The treatment of AC is based on the disease severity, the presence of complications, and pre-existing conditions and comorbidities. ELC represents the cornerstone in the treatment of AC, but, in some circumstances, when ELC is contraindicated, delayed surgery is performed. […] In the course of AC, clinicians should keep the patient on fasting and initiate antimicrobial therapy. […] 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.

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

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

  Your doctor may use abdominal ultrasound, abdominal CT, magnetic resonance cholangiopancreatography (MRCP) or nuclear imaging to help diagnose your condition. […] Your doctor may order blood tests to see if you have a gallbladder infection. Often, the white blood cell count in our blood may become elevated as a sign of the infection. One or more of the following radiology tests also may be done: […] Abdominal ultrasound: This is often the first test done to evaluate for cholecystitis. Ultrasound uses sound waves to produce pictures of the gallbladder and the bile ducts. It is used to identify signs of inflammation involving the gallbladder and is very good at showing gallstones. […] Abdominal CT: Computed tomography (CT) uses x-rays to produce detailed pictures of the abdomen, liver, gallbladder, bile ducts and intestine to help identify inflammation of the gallbladder or blocked bile flow.

• #33 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. […] In these patients, possible diagnoses include abscess, pancreatitis, ischemic bowel, or other abdominal inflammatory conditions. […] 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.

• #34 Acute Cholecystitis – Core EM

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

  CT: Higher accuracy than US for defining complications related to cholecystitis (gangrene, emphysematous cholecystitis). […] Nuclear Scintigraphy with Technetium-99m-labeled hepatobiliary iminodiacetic acid (HIDA) is the gold standard for diagnosis with high sensitivity and specificity. Positive study: Failure of HIDA to outline the gallbladder within 1 hour of administration.

• #35 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.

• #36 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

  The diagnosis of cholecystitis on an US was made if 2 major criteria or 1 major and 2 minor criteria were met. The major criteria included sonographic Murphy sign, gallbladder wall thickening > 3 mm, and pericholecystic fluid. The minor criteria included intra- or extrahepatic biliary dilatation and gallbladder hydrops (transverse diameter > 5 cm). The diagnosis of cholecystitis on CT scan was made in case of ≥ 2 of the following criteria: Gallbladder distention, wall thickening > 4 mm, mucosal hyper enhancement, or pericholecystic fat stranding or fluid. […] Our results demonstrated that CT yielded a specificity of 100% and a sensitivity of 85% with an NPV of 77%. Sonography demonstrated a specificity of 100% and a sensitivity of 72% with an NPV of 77% in our retrospective analyses. […] We thus conclude that CT is comparable to US for the diagnosis of acute cholecystitis. We also recommend US as the first choice for acute right-upper abdominal pain with a suspected history of gall stone disease. If these findings are unclear, CT can provide a useful supplement radiological examination with a high overall accuracy for the diagnosis of acute cholecystitis.

• #37 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).

• #38 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.

• #39 Understanding Cholecystitis: A Comprehensive Patient Guide | Symptoms, Causes, Diagnosis and Treatment Options Explained – The Kingsley Clinic

  https://thekingsleyclinic.com/uncategorized/understanding-cholecystitis-a-comprehensive-patient-guide-symptoms-causes-diagnosis-and-treatment-options-explained/

  MRCP is a type of MRI test specifically designed to visualize the bile ducts, gallbladder, and pancreatic ducts. It is used to identify stones, strictures, or other obstructions that could cause cholecystitis. […] ERCP is both a diagnostic and therapeutic procedure. It involves inserting a flexible tube through the mouth and into the small intestine, where a small catheter can be inserted into the bile ducts. […] A HIDA scan is a nuclear imaging test used to visualize the gallbladder and the biliary system. A radioactive tracer is injected into the body and then scanned using a special camera. This test measures how well the gallbladder contracts and empties. […] Blood tests are often used to assess the function of the liver and the level of bilirubin in the blood. Elevated liver enzymes or high bilirubin levels may suggest cholecystitis. […] If all tests come back negative, but symptoms suggestive of cholecystitis persist, it’s important to communicate this to your healthcare provider. Additional tests or consultations with specialists may be needed.

• #40 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.

• #41 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.

• #42 Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

  https://www.mdpi.com/2079-6382/12/3/482

  Recently, endoscopic ultrasound (EUS) is considered as an important diagnostic tool for gallbladder disease, although there is no specific indication on EUS in AC diagnosis, with other modalities more cost-effective in this setting. […] It is recommended to undertake direct biliary cultures following percutaneous drainage or surgery, particularly in cases of severe ACC. […] The treatment of cholecystitis with antibiotics is often mandatory since recently it has been shown that most of the causes leading to the development of cholecystitis are determined by pathogenic bacteria that enter the biliary excretion system with blood or lymph from other organs, either via the downlink or uplink pathway from the digestive tract. […] A randomized trial looked at 84 patients, 42 of whom were given preoperative antibiotic therapy with amoxicillin/clavulanic acid, and then underwent delayed CCY, e.g., at 6–8 weeks after the diagnosis of mild ACC.

• #43 Gallbladder Disease: Pathophysiology, Diagnosis, and Treatment

  https://www.uspharmacist.com/article/gallbladder-disease-pathophysiology-diagnosis-and-treatment

  If choledocholithiasis is suspected, endoscopic retrograde cholangiopancreatography (ERCP) may be beneficial. […] Noninvasive techniques, such as endoscopic ultrasonography, may be used to detect cholelithiasis, but not to remove the stones. […] Magnetic resonance cholangiopancreatography (MRCP) is an imaging method used to detect choledocholithiasis and other abnormalities of the biliary tract.

• #44 Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

  https://www.mdpi.com/2079-6382/12/3/482

  Recently, endoscopic ultrasound (EUS) is considered as an important diagnostic tool for gallbladder disease, although there is no specific indication on EUS in AC diagnosis, with other modalities more cost-effective in this setting. […] It is recommended to undertake direct biliary cultures following percutaneous drainage or surgery, particularly in cases of severe ACC. […] The treatment of cholecystitis with antibiotics is often mandatory since recently it has been shown that most of the causes leading to the development of cholecystitis are determined by pathogenic bacteria that enter the biliary excretion system with blood or lymph from other organs, either via the downlink or uplink pathway from the digestive tract. […] A randomized trial looked at 84 patients, 42 of whom were given preoperative antibiotic therapy with amoxicillin/clavulanic acid, and then underwent delayed CCY, e.g., at 6–8 weeks after the diagnosis of mild ACC.

• #45 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. […] MRI is sensitive in the detection of acute cholecystitis, with findings similar to those seen on ultrasound and CT. […] Diagnosis of acute cholecystitis can be supported if one major and two minor criteria are present.

• #46 Acute cholecystitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-cholecystitis/

  Diagnostic criteria for acute cholecystitis include local signs of inflammation such as Murphy sign and RUQ pain, systemic signs of inflammation like fever and leukocytosis, and any imaging finding characteristic of acute cholecystitis. […] The initial procedure and duration of antibiotic therapy depend on severity grading of acute cholecystitis, patient’s individual surgical risk, and presence of complications.

• #47 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

  The diagnosis of cholecystitis on an US was made if 2 major criteria or 1 major and 2 minor criteria were met. The major criteria included sonographic Murphy sign, gallbladder wall thickening > 3 mm, and pericholecystic fluid. The minor criteria included intra- or extrahepatic biliary dilatation and gallbladder hydrops (transverse diameter > 5 cm). The diagnosis of cholecystitis on CT scan was made in case of ≥ 2 of the following criteria: Gallbladder distention, wall thickening > 4 mm, mucosal hyper enhancement, or pericholecystic fat stranding or fluid. […] Our results demonstrated that CT yielded a specificity of 100% and a sensitivity of 85% with an NPV of 77%. Sonography demonstrated a specificity of 100% and a sensitivity of 72% with an NPV of 77% in our retrospective analyses. […] We thus conclude that CT is comparable to US for the diagnosis of acute cholecystitis. We also recommend US as the first choice for acute right-upper abdominal pain with a suspected history of gall stone disease. If these findings are unclear, CT can provide a useful supplement radiological examination with a high overall accuracy for the diagnosis of acute cholecystitis.

• #48

  https://link.springer.com/article/10.1007/s00261-024-04691-0

  In this review, we highlight current understanding of the pathogenesis of acalculous cholecystitis, as well as its key imaging and clinical features. […] The clinical and imaging findings are often nonspecific and an index of suspicion from both the clinical team and the radiologist are needed to avoid a delay in diagnosis. […] A definite diagnosis is established if there are positive findings from all three categories. […] The current guidelines on diagnostic criteria were shown in a multicenter validation study to have a sensitivity of 91.2% and specificity of 96.9%. […] While the sensitivity and specificity of hepatobiliary scintigraphy is superior to US, TG recommends US as the first choice of imaging due to its low cost and ease of use while CT or MRI is recommended if a definite diagnosis cannot be provided.

• #49 Chronic Cholecystitis: Causes, Symptoms & Diagnosis

  https://www.healthline.com/health/chronic-cholecystitis

  What is chronic cholecystitis? […] Cholecystitis is the sudden inflammation of your gallbladder. […] When you experience repeated or prolonged attacks of cholecystitis, it becomes a chronic condition. […] Your doctor will take your medical history and conduct a physical exam. The symptoms of cholecystitis are similar to those of other conditions, so they must rule out those conditions. […] There are tests that can help diagnose cholecystitis: The CT scan uses X-rays to produce very detailed pictures of your abdomen. This is the most sensitive test, and is likely the best bet in locating the problem. […] Your healthcare team will advise you about lifestyle and dietary guidelines that can also improve your condition. […] If you’ve had one or more bouts of cholecystitis, speak to your doctor to learn about changes you can make to avoid chronic cholecystitis.

• #50 Chronic Cholecystitis – Hepatic and Biliary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/chronic-cholecystitis

  Chronic cholecystitis is suspected in patients with recurrent biliary colic plus gallstones. Ultrasonography or another imaging test usually shows gallstones and sometimes a shrunken, fibrotic gallbladder. The diagnosis is made in patients with a history of recurrent biliary colic and ultrasonographic evidence of gallstones. […] Cholescintigraphy may show nonvisualization of the gallbladder but is less accurate.

• #51 Diagnosing Biliary Colic and Acute Cholecystitis | AAFP

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

  Approximately 500,000 cholecystectomies are performed annually in the United States. Symptomatic gallstones are the most common indication for cholecystectomy. A review by Ahmad and colleagues stressed the importance of differentiating biliary colic and acute cholecystitis. Overlapping symptoms may result in misinterpretation. […] 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.

• #52 Chronic cholecystitis | Radiology Reference Article | Radiopaedia.org

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

  Chronic cholecystitis refers to prolonged inflammatory condition that affects the gallbladder. It is almost always seen in the setting of cholelithiasis (95%), caused by intermittent obstruction of the cystic duct or infundibulum, or dysmotility. […] Hepatobiliary scintigraphy may be required to distinguish acute from chronic cholecystitis and to evaluate gallbladder dysmotility by calculation of the gallbladder ejection fraction. […] HIDA scan can be of particular benefit in cases where the diagnosis is uncertain and for differentiation from acute cholecystitis. Delayed visualization of the gallbladder between 1-4 hours is a reliable sign of chronic cholecystitis. […] Chronic cholecystitis may be diagnosed by calculating the percentage of isotope excreted (ejection fraction) from the gallbladder following cholecystokinin or after a fatty meal.

• #53 ICD-10-CM/PCS MS-DRG v37.2 Definitions Manual

  https://www.cms.gov/icd10m/version372-fullcode-cms/fullcode_cms/P0181.html

  K810 Acute cholecystitis […] K811 Chronic cholecystitis […] K812 Acute cholecystitis with chronic cholecystitis […] K819 Cholecystitis, unspecified […] K82A1 Gangrene of gallbladder in cholecystitis […] K82A2 Perforation of gallbladder in cholecystitis

• #54 Exploring Differential Diagnosis for Cholecystitis – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/exploring-differential-diagnosis-for-cholecystitis/

  Exploring Differential Diagnosis for Cholecystitis Cholecystitis, inflammation of the gallbladder, can present with symptoms such as severe abdominal pain, fever, nausea, and vomiting. However, these symptoms can also be indicative of other conditions, making differential diagnosis crucial for accurate treatment. By considering the patient’s medical history, conducting physical examinations, and utilizing advanced diagnostic tools, healthcare professionals can identify the underlying cause of cholecystitis and develop a targeted treatment plan. […] In collaboration with Acibadem Healthcare Group, a renowned healthcare provider, we will outline the various diagnostic methods used in differentiating cholecystitis from other conditions that may present similar symptoms. Acibadem is well-equipped with state-of-the-art facilities and a team of experienced specialists who prioritize accurate diagnosis and effective treatment for cholecystitis patients.

• #55

  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.

• #56 Acute Acalculous Cholecystitis | Applied Radiology

  https://appliedradiology.com/articles/acute-acalculous-cholecystitis

  Acute acalculous cholecystitis. […] The differential diagnosis includes acute calculous cholecystitis, acute pancreatitis, hepatic abscess, or right sided pyelonephritis. […] Acute acalculous cholecystitis (AAC) may be suspected in pediatric patients presenting with abdominal pain, signs of sepsis without a clear source, or with jaundice. […] Ultrasound is the preferred imaging modality for initial assessment owing to its greater availability, short examination time, and lack of ionizing radiation. […] In the absence of gallstones, at least two of the following findings are required to diagnose cholecystitis: GB wall edema, increased wall thickness (3.5-4 mm), pericholecystic fluid, intraluminal sludge, or GB distention. […] AAC is diagnosed on HIDA when the GB is not visualized 1 hour postinjection with radiolabeled technetium.

• #57 Treatment of acute calculous cholecystitis – UpToDate

  https://www.uptodate.com/contents/treatment-of-acute-calculous-cholecystitis

  Acute cholecystitis is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. It typically occurs in patients with gallstones (ie, acute calculous cholecystitis [ACC]), while acalculous cholecystitis accounts for a minority (5 to 10 percent) of cases. Complications of acute cholecystitis include gallbladder gangrene or perforation, which can be life-threatening. […] Patients with ACC usually present with severe and steady abdominal pain in the right upper quadrant or epigastrium, fever, and leukocytosis. A positive Murphy’s sign on physical examination supports the diagnosis. In most cases, the diagnosis can be established with an abdominal ultrasound or a cholescintigraphy if the ultrasound is equivocal. […] Cholecystectomy is the mainstay of treatment for ACC. Poor surgical candidates may benefit from initial nonoperative management with antibiotics and a gallbladder drainage procedure; those whose surgical risk improves after resolution of the acute inflammation should undergo elective gallbladder surgery to prevent recurrent symptoms.

• #58 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. […] 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.

• #59 Acalculous cholecystitis – EMCrit Project

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

  Be careful interpreting radiologic studies of the gallbladder in critically ill patients, because these patients often have moderately abnormal gallbladders at baseline (e.g. pericholecystic fluid and increased wall thickness due to volume overload). […] HIDA scan probably doesn’t add much meaningful information to ultrasound or CT scan.

• #60 Acalculous Cholecystitis | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688222/all/Acalculous_Cholecystitis

  Acalculous cholecystitis, also known as acute alithiasic cholecystitis (AAC), is an acute necroinflammatory disease of the gallbladder occurring in the absence of cholelithiasis (1) with a multifactorial pathogenesis (2). […] The diagnosis of AAC can be challenging and relies on accurate history, physical examination, laboratory, and imaging (1). […] Early diagnosis improves outcomes (4). […] Laboratory tests in patients with acalculous cholecystitis are nonspecific. […] Confirmation of AAC typically requires imaging, most commonly abdominal ultrasound. […] If the diagnosis remains unclear, cholescintigraphy can be obtained. […] Ultrasound is the imaging modality of choice for diagnosis.

• #61 Acute Acalculous Cholecystitis | Applied Radiology

  https://appliedradiology.com/articles/acute-acalculous-cholecystitis

  Acute acalculous cholecystitis. […] The differential diagnosis includes acute calculous cholecystitis, acute pancreatitis, hepatic abscess, or right sided pyelonephritis. […] Acute acalculous cholecystitis (AAC) may be suspected in pediatric patients presenting with abdominal pain, signs of sepsis without a clear source, or with jaundice. […] Ultrasound is the preferred imaging modality for initial assessment owing to its greater availability, short examination time, and lack of ionizing radiation. […] In the absence of gallstones, at least two of the following findings are required to diagnose cholecystitis: GB wall edema, increased wall thickness (3.5-4 mm), pericholecystic fluid, intraluminal sludge, or GB distention. […] AAC is diagnosed on HIDA when the GB is not visualized 1 hour postinjection with radiolabeled technetium.

• #62 Hemorrhagic Cholecystitis | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v2n5/jiang-hemorrhagic/

  A male patient presented with a case of hemorrhagic cholecystitis that, due to delay in diagnosis, resulted in death. […] Our aim is to increase the awareness of this fatal complication of a fairly common disease and review the fundamentals of diagnosis and management of hemorrhagic cholecystitis. […] This case and our literature review illustrate the opportunity for further education about this rare complication of a common pathophysiology. […] Hemorrhagic cholecystitis is a rare complication of this disease process. […] Despite the high incidence of acute cholecystitis, we were able to find only 32 hemorrhagic cases reported in the literature. […] The degree of hemorrhage varies from asymptomatic to hemodynamically unstable. […] There exist no guidelines for diagnosis or treatment of this disease.

• #63

  https://link.springer.com/article/10.1007/s44326-024-00034-x

  Haemorrhagic cholecystitis is diagnosed by radiographic imaging. The first-choice exam is ultrasonography. However, ultrasound does not appear to be ideal for differentiating between acute and haemorrhagic cholecystitis. Computed tomography (CT) scan is the gold standard in the diagnosis of haemorrhagic cholecystitis. […] Clinical diagnosis is challenging as it presents with vague symptoms, particularly upper quadrant pain, making it difficult to distinguish from uncomplicated acute cholecystitis. Imaging plays a crucial role in diagnosis, with abdominal ultrasound being a first-line investigation but not specific in differentiating among various forms of cholecystitis, and CT representing the diagnostic gold standard. […] The diagnostic work-up should start with a thorough patient history and assessment of risk factors, combined with clinical, laboratory, and imaging examinations, the findings of which should be able to distinguish acute lithiasic cholecystitis from haemorrhagic cholecystitis. The latter has nonspecific radiographic features, but irregular walls and abundant hyperechoic endoluminal material resembling biliary sludge are frequently found on ultrasound; CT imaging reveals spontaneously hyperdense endoluminal material not enhancing with contrast medium, raising suspicion of haemorrhage. […] Regardless of the cause, in most cases, haemorrhagic cholecystitis requires immediate surgical intervention. Treatment should be dictated by the patients symptoms and overall clinical condition. In patients not candidates for surgical intervention, cholecystostomy may be considered.

• #64 Hemorrhagic Cholecystitis | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v2n5/jiang-hemorrhagic/

  Our experience with one such case, and our review of the literature, allowed us to attempt to generalize how best to diagnose and manage hemorrhagic cholecystitis. […] In the cases we reviewed, right upper quadrant ultrasound and CT scan of the abdomen and pelvis were the most common initial imaging studies in these patients. […] The initial imaging study of choice for biliary disease is ultrasonography. […] However, ultrasound does not appear to be ideal for differentiating between acute and hemorrhagic cholecystitis. […] We conclude that CT scan is useful in the diagnosis of hemorrhagic cholecystitis. […] We propose limiting the diagnosis of hemorrhagic cholecystitis to patients that present with signs and symptoms consistent with acute cholecystitis PLUS signs and symptoms of hemorrhage (hypotension, lethargy, melena, anemia), or imaging evidence of hemorrhage.

• #65

  https://link.springer.com/article/10.1007/s44326-024-00034-x

  Haemorrhagic cholecystitis is diagnosed by radiographic imaging. The first-choice exam is ultrasonography. However, ultrasound does not appear to be ideal for differentiating between acute and haemorrhagic cholecystitis. Computed tomography (CT) scan is the gold standard in the diagnosis of haemorrhagic cholecystitis. […] Clinical diagnosis is challenging as it presents with vague symptoms, particularly upper quadrant pain, making it difficult to distinguish from uncomplicated acute cholecystitis. Imaging plays a crucial role in diagnosis, with abdominal ultrasound being a first-line investigation but not specific in differentiating among various forms of cholecystitis, and CT representing the diagnostic gold standard. […] The diagnostic work-up should start with a thorough patient history and assessment of risk factors, combined with clinical, laboratory, and imaging examinations, the findings of which should be able to distinguish acute lithiasic cholecystitis from haemorrhagic cholecystitis. The latter has nonspecific radiographic features, but irregular walls and abundant hyperechoic endoluminal material resembling biliary sludge are frequently found on ultrasound; CT imaging reveals spontaneously hyperdense endoluminal material not enhancing with contrast medium, raising suspicion of haemorrhage. […] Regardless of the cause, in most cases, haemorrhagic cholecystitis requires immediate surgical intervention. Treatment should be dictated by the patients symptoms and overall clinical condition. In patients not candidates for surgical intervention, cholecystostomy may be considered.

• #66 Cholecystitis – Diagnosis & Treatment

  https://www.arnoldpalmerhospital.com/pediatric-specialties/pediatric-surgery/conditions/cholecystitis/diagnosis-and-treatment

  Your child will undergo one or more of the following tests to diagnose cholecystitis: […] Blood test. Your childs doctor may use blood tests to check for signs of infection or issues with the gallbladder. […] Imaging tests. Your childs doctor may order imaging tests such as an abdominal ultrasound, endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP) or computerized tomography (CT) scan to obtain detailed images of your childs gallbladder and surrounding structures. […] Hepatobiliary iminodiacetic acid (HIDA) scan. This test checks how bile moves through your childs body. A HIDA scan can locate any blockages or issues with the bile ducts (tubes that go from the liver to the small intestines) or gallbladder.

• #67 Cholecystitis | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/cholecystitis/

  What tests are used to diagnose cholecystitis? Your childs doctor will recommend one or more tests to help us diagnose your child. These tests may include: Blood work to check their liver and pancreas function, electrolytes and signs of infection. An abdominal ultrasound. […] How do we diagnose cholecystitis? We diagnose cholecystitis using your childs medical history, physical exam, and laboratory or ultrasound data that show gallstones and an inflamed gallbladder. We customize your childs diagnosis and treatment to their specific needs, working closely with specialists in gastroenterology and hepatology.

• #68

  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.

• #69

  https://journals.lww.com/ajg/fulltext/2018/10001/gangrenous_cholecystitis_missed_on_imaging__2909.2908.aspx

  Despite advances in the radiologic investigations, the diagnosis of acute cholecystitis is still challenging. […] This report sheds light on the limitations of diagnostic testing and clinical signs in the diagnosis of acute cholecystitis. […] Although there are multiple tools that are highly specific for the detection of acute cholecystitis, the accuracy of those tests for diagnosing GC remains uncertain. […] Careful history and physical examination are essential in making a diagnosis. […] Diagnostic testing may be misleading and patients with a high index of suspicion should be evaluated by an experienced surgeon and offered elective Laparoscopic cholecystectomy as clinically indicated.

• #70 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. […] 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.

• #71

  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.

• #72 Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

  https://www.mdpi.com/2079-6382/12/3/482

  In contrast, as for ACC without gallstones, the symptoms are similar to those with gallstones, but it could be difficult to identify because patients tend to be critically ill (e.g., in intensive care units) and may not be able to communicate clearly. […] The diagnosis is often delayed either because the patient does not accept the doctor’s advice or the surgeon is not consulted early enough.

• #73 Diagnosing Biliary Colic and Acute Cholecystitis | AAFP

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

  Approximately 500,000 cholecystectomies are performed annually in the United States. Symptomatic gallstones are the most common indication for cholecystectomy. A review by Ahmad and colleagues stressed the importance of differentiating biliary colic and acute cholecystitis. Overlapping symptoms may result in misinterpretation. […] 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.

• #74 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.

• #75 Acute Cholecystitis: Practice Essentials, Background, Pathophysiology

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

  Delays in making the diagnosis of acute cholecystitis result in a higher incidence of morbidity and mortality. […] The diagnosis should be considered and the patient evaluated promptly to prevent poor outcomes. […] Initial treatment of acute cholecystitis includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. […] If surgical treatment is indicated, laparoscopic cholecystectomy represents the standard of care.

• #76 Diagnosis of Acute Cholecystitis | CDA-AMC

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

  The initial treatment for acute cholecystitis in the emergency room is usually intravenous antibiotics, hydration, and analgesia. If inflammation of the gallbladder continues, removal of the gallbladder (cholecystectomy) is usually required. […] Complications of acute cholecystitis include gangrenous cholecystitis (gangrene of the gallbladder wall), gallbladder perforation (hole or piercing of the wall of the gallbladder), and emphysematous cholecystitis (acute infection of the gallbladder caused by gas-forming organisms). These complications occur in up to 20% of people with cholecystitis, have high mortality associated with them, and therefore require emergency surgery. […] Cholescintigraphy, also known as a hepatobiliary iminodiacetic (HIDA) scan, is a nuclear medicine test used to diagnose intrahepatic or extrahepatic obstruction of the bile ducts, gallbladder disease, and bile leaks.

• #77 Cholecystitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-20364867

  Cholecystitis (ko-luh-sis-TIE-tis) is swelling and irritation, called inflammation, of the gallbladder. […] Most often, gallstones that block the tube leading out of the gallbladder cause cholecystitis. […] If not treated, cholecystitis can lead to serious complications, such as gallbladder rupture. […] Treatment for cholecystitis often involves surgery to remove the gallbladder. […] Cholecystitis is when your gallbladder is inflamed. […] Gallbladder inflammation can be caused by: […] Most often, cholecystitis is the result of hard particles of bile that can form in the gallbladder, called gallstones. […] Cholecystitis that isn’t treated can cause tissue in the gallbladder to die. […] This is called gangrene. […] A tear, called a perforation, in the gallbladder may result from gallbladder swelling or infection or the death of gallbladder tissue.

• #78 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.

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

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

  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. […] The treatment of AC is based on the disease severity, the presence of complications, and pre-existing conditions and comorbidities. ELC represents the cornerstone in the treatment of AC, but, in some circumstances, when ELC is contraindicated, delayed surgery is performed. […] In the course of AC, clinicians should keep the patient on fasting and initiate antimicrobial therapy. […] 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.

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

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

  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.

• #81 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%.

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

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

  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. […] The treatment of AC is based on the disease severity, the presence of complications, and pre-existing conditions and comorbidities. ELC represents the cornerstone in the treatment of AC, but, in some circumstances, when ELC is contraindicated, delayed surgery is performed. […] In the course of AC, clinicians should keep the patient on fasting and initiate antimicrobial therapy. […] 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.

• #83 Acute cholecystitis

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

  Acute cholecystitis is inflammation of the gallbladder. It usually needs to be treated in hospital with rest, intravenous fluids and antibiotics. […] 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.

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

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

  If you suspect acute cholecystitis, we advise you to seek help from a general surgery clinic immediately or call 995 to contact a nearby hospitals Accident Emergency (AE) Department. This is because timely treatment of gallbladder inflammation is necessary to prevent serious complications. […] A common treatment for acute cholecystitis is removing the inflamed gallbladder through laparoscopic (key-hole) surgery. […] Following a thorough evaluation, a personalised treatment plan will be proposed, precisely tailored to your unique condition. […] When complications arise and for severe cases, surgery is often necessary to effectively treat acute cholecystitis. The standard treatment for acute cholecystitis is surgical removal of the gallbladder, known as cholecystectomy. […] In conclusion, acute cholecystitis, the inflammation of the gallbladder, is a medical emergency. This is because the serious condition often results in life-threatening complications if left untreated. Patients with acute cholecystitis should seek urgent medical attention as soon as possible to prevent complications.

• #85 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.

• #86 Cracking the Code: How Doctors Diagnose Acute Cholecystitis – Doctronic, Your Trusted AI Doctor

  https://www.doctronic.ai/conditions-diseases/cracking-the-code-how-doctors-diagnose-acute-cholecystitis-A3hZsB

  Diagnosing acute cholecystitis is like solving a medical mystery. Doctors use a combination of physical exams, blood tests, and imaging studies to piece together the puzzle and confirm the diagnosis. The first step in diagnosing acute cholecystitis is a thorough physical examination. Doctors look for key signs like right upper abdominal pain and fever. A special test called Murphy’s sign is often performed. During this test, the doctor presses on the gallbladder area while the patient takes a deep breath. If this causes pain or catches the patient’s breath, it’s a positive Murphy’s sign and suggests gallbladder inflammation. Blood tests provide important clues about what’s happening inside the body. In acute cholecystitis, doctors typically see an elevated white blood cell count, indicating infection or inflammation. They also check liver function tests and may see mild elevations in certain enzymes. These tests are like reading the body’s internal report card – they give doctors valuable information about what’s going on beneath the surface. Acute cholecystitis is an inflammation of the gallbladder, often caused by gallstones blocking the cystic duct. It is diagnosed through physical exams, blood tests, and imaging studies. Imaging tests are crucial for confirming the diagnosis of acute cholecystitis. Ultrasound is usually the first choice. It can show gallstones, gallbladder wall thickening, and fluid around the gallbladder – all signs of inflammation. Think of ultrasound as a window into the body, allowing doctors to see the gallbladder in real-time. If ultrasound results are unclear, doctors may use other imaging tests like CT scans or a special nuclear medicine test called a HIDA scan. Diagnosing acute cholecystitis is rarely based on a single test. Instead, doctors consider the whole picture – symptoms, physical exam findings, lab results, and imaging studies. It’s like assembling a jigsaw puzzle, where each piece of information helps complete the diagnostic picture. This comprehensive approach helps ensure an accurate diagnosis and guides appropriate treatment. With today’s advanced diagnostic tools, doctors can accurately identify acute cholecystitis and start appropriate treatment quickly.

• #87 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

  To evaluate the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis in comparison with other imaging modalities. […] Sonography is still used as the initial imaging technique for evaluating patients with suspected acute calculous cholecystitis because of its high sensitivity at the detection of GB stones, its real-time character, and its speed and portability. […] US is currently considered the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis. […] Ultrasound (US) is the preferred imaging examination for the diagnosis of acute cholecystitis and is the first method used when the clinical presentation is suggestive of biliary pathology. […] Ultrasound has the best sensitivity and specificity for evaluating patients with suspected gallstones.

• #88 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.

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

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

  Your doctor may use abdominal ultrasound, abdominal CT, magnetic resonance cholangiopancreatography (MRCP) or nuclear imaging to help diagnose your condition. […] Your doctor may order blood tests to see if you have a gallbladder infection. Often, the white blood cell count in our blood may become elevated as a sign of the infection. One or more of the following radiology tests also may be done: […] Abdominal ultrasound: This is often the first test done to evaluate for cholecystitis. Ultrasound uses sound waves to produce pictures of the gallbladder and the bile ducts. It is used to identify signs of inflammation involving the gallbladder and is very good at showing gallstones. […] Abdominal CT: Computed tomography (CT) uses x-rays to produce detailed pictures of the abdomen, liver, gallbladder, bile ducts and intestine to help identify inflammation of the gallbladder or blocked bile flow.

• #90 Understanding Cholecystitis: A Comprehensive Patient Guide | Symptoms, Causes, Diagnosis and Treatment Options Explained – The Kingsley Clinic

  https://thekingsleyclinic.com/uncategorized/understanding-cholecystitis-a-comprehensive-patient-guide-symptoms-causes-diagnosis-and-treatment-options-explained/

  Diagnosing cholecystitis involves a thorough evaluation of the patient’s symptoms, medical history, and results from specific diagnostic tests. The goal is to confirm the presence of inflammation in the gallbladder and rule out other possible causes of the symptoms. This process may involve several types of tests, including imaging studies and blood tests. […] The abdominal ultrasound is a non-invasive imaging test and is typically the first step in diagnosing cholecystitis. It uses sound waves to create images of the gallbladder and surrounding structures, allowing healthcare providers to identify gallstones, gallbladder wall thickening, and fluid around the gallbladder – signs indicative of cholecystitis. […] An abdominal CT scan is a type of imaging test that provides detailed pictures of the gallbladder and surrounding organs. It can help detect inflammation, gallstones, and complications of cholecystitis such as perforation or abscess.

• #91 Acute Cholecystitis: Practice Essentials, Background, Pathophysiology

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

  Delays in making the diagnosis of acute cholecystitis result in a higher incidence of morbidity and mortality. […] The diagnosis should be considered and the patient evaluated promptly to prevent poor outcomes. […] Initial treatment of acute cholecystitis includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. […] If surgical treatment is indicated, laparoscopic cholecystectomy represents the standard of care.

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

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

  If you suspect acute cholecystitis, we advise you to seek help from a general surgery clinic immediately or call 995 to contact a nearby hospitals Accident Emergency (AE) Department. This is because timely treatment of gallbladder inflammation is necessary to prevent serious complications. […] A common treatment for acute cholecystitis is removing the inflamed gallbladder through laparoscopic (key-hole) surgery. […] Following a thorough evaluation, a personalised treatment plan will be proposed, precisely tailored to your unique condition. […] When complications arise and for severe cases, surgery is often necessary to effectively treat acute cholecystitis. The standard treatment for acute cholecystitis is surgical removal of the gallbladder, known as cholecystectomy. […] In conclusion, acute cholecystitis, the inflammation of the gallbladder, is a medical emergency. This is because the serious condition often results in life-threatening complications if left untreated. Patients with acute cholecystitis should seek urgent medical attention as soon as possible to prevent complications.

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