Ultrasonography of cholecystitis
Revision as of 16:17, 6 December 2018 by Mikael Häggström (talk | contribs) (→Evaluation: +General)
Author:
Mikael Häggström [notes 1]
Ultrasonography of suspected cholecystitis.
Contents
Planning
Choice of modality
- Right upper quadrant abdominal ultrasonography of cholecystitis is generally the first exam of choice.[1][2][3]
- Abdominal CT may be used if complications such as perforation or gangrene are suspected.[4] In adults, acute abdominal symptoms that are rather unspecific also indicate CT.
How soon
After 8 hours of fasting in order to distend the gallbladder.[5]
Evaluation
Ultrasound findings suggestive of acute cholecystitis include:[6]
- Gallstones
- Pericholecystic fluid
- Gallbladder wall thickening (wall thickness over 3 mm)[7]
- Dilation of the bile duct, and a sonographic Murphy's sign. A sonographic Murphy's sign which is where the patient experiences pain by pressure upon the gallbladder with the ultrasound probe in inspired state.[8][9]
It is also appropriate to perform a general upper abdominal screening.
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Strasberg, SM (26 June 2008). "Clinical practice. Acute calculous cholecystitis. ". The New England Journal of Medicine 358 (26): 2804–11. doi:. PMID 18579815.
- ↑ "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease ". Arch. Intern. Med. 154 (22): 2573–81. November 1994. doi:. PMID 7979854.
- ↑ "The sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis ". Arch Surg 120 (8): 904–6. August 1985. doi:. PMID 3893388.
- ↑ Friedman L.S. (2015). Liver, Biliary Tract, & Pancreas Disorders. In Papadakis M.A., McPhee S.J., Rabow M.W. (Eds), Current Medical Diagnosis & Treatment 2015
- ↑ Alan A Bloom. Cholecystitis Workup. medscape. Updated: Nov 08, 2017
- ↑ Greenberger N.J., Paumgartner G (2012). Chapter 311. Diseases of the Gallbladder and Bile Ducts. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison's Principles of Internal Medicine, 18e
- ↑ van Breda Vriesman, Adriaan C.; Engelbrecht, Marc R.; Smithuis, Robin H. M.; Puylaert, Julien B. C. M. (2007). "Diffuse Gallbladder Wall Thickening: Differential Diagnosis ". American Journal of Roentgenology 188 (2): 495–501. doi:. ISSN 0361-803X.
- ↑ Urbano FL and Carroll M, Hospital Physician, November 2000: p51-52 (includes a description of the Murphy sign, and an erroneous description of the sonographic Murphy sign)
- ↑ Orient JM, Sapira's Art & Science of Bedside Diagnosis 3e, 2005, Lippincott Williams & Wilkins, p461 (describes one method in detail for eliciting the Murphy sign)
