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.
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.
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.
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.
a, b Acute cholecystitis. The edematous wall of the gallbladder (GB) appears thickened and shows a distinct layered structure. L = liver
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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