History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis

Jain, Ankur; Mehta, Ninfa; Secko, Michael; Schechter, J.; Papanagnou, Dimitrios; Pandya, Shreya; Sinert, Richard

doi:10.1111/acem.13132

Cited by 47 publications

(35 citation statements)

References 41 publications

(114 reference statements)

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“…Multiple studies have examined the diagnostic accuracy of history, physical examination, and laboratory tests for cholecystitis 6 and a meta-analysis quantitatively showed that POCUS consistently surpassed all other bedside investigations for sensitivity for the diagnosis of biliary disease. 7 Additionally, POCUS has been studied for accuracy with a recent systematic review showing the sensitivity and specificity for cholelithiasis is 89.8% and 88.0%, respectively. 8 POCUS has also been assessed for the diagnosis of acute cholecystitis and found to be highly sensitive and specific (87% and 82%) when the criteria of gallstones plus an additional finding of a sonographic Murphy’s sign, gallbladder wall thickness, or pericholecystic fluid is used for assessment.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Hilsden

Leeper

Koichopolos

et al. 2018

Trauma Surg Acute Care Open

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BackgroundPatients with uncomplicated biliary disease frequently present to the emergency department for assessment. To improve bedside clinical decision making, biliary point-of-care ultrasound (POCUS) in the emergency department has emerged as a diagnostic tool. The purpose of this study is to analyze the usefulness of POCUS in predicting the need for surgical intervention in biliary disease.MethodsA retrospective study of patients visiting the emergency department who received a biliary POCUS from December 1, 2016 to July 15, 2017 was performed. The physician interpretations of the biliary POCUS scans were collected, as well as data from the electronic health records including lab values, the subsequent use of diagnostic imaging, surgical consultation or intervention, and 28 days follow-up for representation or complication.ResultsTwo hundred and eighty-three patients were identified as having received biliary POCUS. Of the patients referred to general surgery who received biliary POCUS 43% received a cholecystectomy. For the outcome of cholecystectomy, the finding of gallstones on POCUS was 55% sensitive (95% CI 40% to 70%) and 92% specific (95% CI 87% to 95%). A sonographic Murphy’s sign was 16% sensitive (95% CI 7% to 30%) but 95% specific (95% CI 92% to 97%) and, gallbladder wall thickness was 18% sensitive (95% CI 9% to 33%) and 98% specific (95% CI 95% to 99%). Patients who received POCUS but did not proceed to confirmatory radiology department imaging had a shorter length of stay (433 min ± 50 min vs. 309 min ± 30 min, P<0.001).DiscussionPoint-of-care biliary ultrasound performed by emergency physicians provides timely access to diagnostic information. Positive findings of gallstones and increased gallbladder wall thickness are highly predictive of the need for surgical intervention, and use of POCUS is associated with shorter ER visits.Level of evidenceRetrospective cohort study, level III.

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Section: Introductionmentioning

confidence: 99%

Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Hilsden

Leeper

Koichopolos

et al. 2018

Trauma Surg Acute Care Open

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“…In the COVID-19 pandemic period, as a disease severity laboratory test for many inflammatory diseases such as acute cholecystitis and acute appendicitis, acute-phase reactants including leukocyte and CRP are expected to increase because of possible delayed hospital admissions of patients 16 . Also, in the COVID-19 disease, it is known that the laboratory findings of leukopenia and high CRP are seen, but in this situation for the differential diagnosis, the clinical presentation of the patient is much more important 17 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes of the patients with acute cholecystitis treated in the COVID-19 pandemic and pre-pandemic period

Lapsekili

Buldanlı

Peker

2021

Rev. Assoc. Med. Bras.

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“…6 Murphy's sign sensitivity was 62% and specificity was 96% for acute cholecysitis diagnosis. 7 The diagnosis is made based on this clinical features and supported by findings from relevant laboratory and imaging studies. The triad of sudden onset of RUQ pain, fever, and leukocytosis is highly suggestive of acute cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

Acute Calculous Cholecystitis in a Young Female Patient: A Unique Case

Shalim¹,

Arianthi²,

Wirawan³

2019

IJMBS

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Acute cholecystitis needs to be rapidly diagnosed and treated correctly. The classic patient characteristics were obese, increasing age, and being female. In a few cases, cholecystitis can occured in an atypical patient, such as in young age. Here, we report a 25-year-old obese female patient that came with right upper abdominal pain which was associated with nausea and vomiting. From imaging studies, we found that she had distended gallbladder with multiple stones. Open cholecystectomy was done and patient did well postoperatively. Acute cholecystitis had to be suspected in all age, especially in patient with another risk factor like obesity in our case. Keywords: acute cholecystitis, gallstone, cholecystectomy

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History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis

Cited by 47 publications

References 41 publications

Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Comparison of outcomes of the patients with acute cholecystitis treated in the COVID-19 pandemic and pre-pandemic period

Acute Calculous Cholecystitis in a Young Female Patient: A Unique Case

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