Right Upper Quadrant Pain: Ultrasound First!

Revzin, Margarita V.; Scoutt, Leslie M.; Garner, Joseph G.; Moore, Christopher L.

doi:10.1002/jum.14274

Cited by 36 publications

(13 citation statements)

References 28 publications

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“…Transabdominal ultrasound is the gold-standard imaging for acute cholecystitis and detects over 80% of cases ( 31 – 35 ). In acute uncomplicated cholecystitis, ultrasound may show gallstones, a positive sonographic Murphy's sign, thickened gallbladder wall, pericholecystic fluid, “sludge” in the gallbladder, gallbladder distension, and hyperaemia of the gallbladder wall on Doppler ( 30 , 36 – 38 ). However, it is limited in detecting severe variants such as gangrenous or emphysematous cholecystitis or intra-abdominal abscess, where CT is more appropriate ( 14 , 24 , 30 , 37 ).…”

Section: Introduction and Objectivesmentioning

confidence: 99%

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

et al. 2020

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Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.

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Section: Introduction and Objectivesmentioning

confidence: 99%

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

et al. 2020

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“…Classically, three clinical presentations appear in cholelithiasis: dyspepsia in 2/3 of the patients, asymptomatic patients that corresponds to around 25%, and the typical painful condition in 10 to 20% of patients [19,20,21] . Most authors consider that abdominal ultrasound is the technique of choice for diagnostic imaging [3,13,[19][20][21][22][23][24][25] .…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Clinical Manifestations of Cholelithiasis in Quito, Ecuador. A Cohort Study

Mario¹,

Mayra²,

Luis³

2021

ajsrr

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Introduction: A prospective study was carried out, with the aim of establishing the clinical manifestations of cholelithiasis in the population of Quito, Ecuador. Methods: During the period from January 2012 to October 2017, 534 patients were referred from different outpatient clinics of the Ecuadorian Institute of Social Security to the Batan Medical Center with the diagnosis of cholelithiasis after a clinical assessment and abdominal ultrasound, to be treated surgically. Results: Sixty-nine percent of patients were female with a male-female ratio of 1:2.21. Mean age was 44.9 years. Pain was the most common symptom in our study: 95.7%. Among these patients, pain was located in the epigastrium in 49.8%, in the right hypochondrium in 45.1% and only 0.8% had low back pain. Pain ranged from moderate and even severe. The remaining 4.3% of patients had dyspepsia or were asymptomatic. Conclusions: This finding highlights the fact that epigastric pain must be always considered as a clinical manifestation on cholelithiasis.

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“…Guidelines and expert opinion recommend an "ultrasound-first" approach when patients present with right upper quadrant (RUQ) abdominal pain or pelvic pain of suspected gynecologic origin. [1][2][3] When evaluating suspected biliary disease, experts recommend beginning with ultrasonography based on the speed of obtaining results, absence of radiation exposure, reduced cost, and good diagnostic accuracy. 1 Ultrasound has superior sensitivity, of 98%, 4 in identifying radiolucent gallstones, compared to CT's 79% sensitivity.…”

Section: Why You Might Consider Ordering An Abdominal Ultrasound Afte...mentioning

confidence: 99%

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Cunningham

Wachtel

Shaffie

et al. 2021

Journal of Hospital Medicine

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Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOA 70-year-old woman presented to the emergency department (ED) with diffuse abdominal pain, nausea, and vomiting with normal liver function tests and lipase. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed no acute intraabdominal pathology except for an incidentally noted, mildly enlarged but nondistended gallbladder without evident cholelithiasis, pericholecystic fluid, or gallbladder wall edema. The hospitalist orders an abdominal ultrasound to evaluate for acute biliary pathology potentially missed by CT.

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Right Upper Quadrant Pain: Ultrasound First!

Cited by 36 publications

References 28 publications

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

Clinical Manifestations of Cholelithiasis in Quito, Ecuador. A Cohort Study

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

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