Upper Abdominal Pain Acute Cholecystitis

Clinical manifestations: Right upper abdominal pain radiating to the right shoulder, fever, possible jaundice (if the edematous inflammatory changes involve the biliary tract). Anorexia; nausea; enlarged, tense, painful gallbladder that may be palpable (Murphy’s sign). Localized rigidity, meteorism, or diminished bowel
sounds due to paralytic ileus may be noted.
Diagnosis :
x History and physical examination
x Laboratory findings: Leukocytosis, g-glutamate transferase (GGT) and alkaline phosphatase (AP) o, possible elevation of direct serum bilirubin, C-reactive protein (CRP) o
x Sonography
x Radiography: Plain abdominal radiograph for suspected emphysematous cholecystitis
x Biliary scintigraphy if the gallbladder cannot be visualized.
Sonographic findings:
x Tenderness to probe pressure over the gallbladder
x Gallbladder wall is thickened, and three distinct layers are visible as a result of edema.
x Borders may be poorly demarcated from surroundings as a result of pericholecystitis
x Gallbladder hydrops may occur with a painful, enlarged, incompressible gallbladder.
image
a, b Acute cholecystitis. The edematous wall of the gallbladder (GB) appears thickened and shows a distinct layered structure. L = liver
image
a, b Gallbladder hydrops in acute cholecystitis. The gallbladder (GB) is enlarged, tender to pressure, and is incompressible with the ultrasound probe. Arrows: shadowing stones (S). L = liver
x Calculi can be detected in up to 95 % of cases.
Accuracy of sonographic diagnosis: Very high, especially when combined with the clinical presentation and history, laboratory findings, and sonographic follow-ups. There is no need for additional imaging studies.
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