| History: Individuals with acute cholecystitis often complain of pain or discomfort in the upper right abdomen in the area of the liver and gallbladder or just under the breastbone. Pain may radiate to the back and shoulder area and may be associated with nausea and vomiting, anorexia and fever. The individual may report several days or weeks of recurring symptoms that tend to occur within an hour after meals, gradually increasing in intensity to become constant, then leveling off and persisting for up to several hours or days.
Individuals with chronic cholecystitis may complain of vague abdominal pain and mild indigestion (dyspepsia) following fatty meals. They may also complain of nausea and an increased frequency of belching. They often will report a history of gallstones and related biliary colic. Physical exam: The individual may have a mild-to-moderate fever indicative of infection. Pressing on (palpating) the abdomen in the area of the gallbladder and liver may reveal local tenderness. While palpating this area, the physician may ask the individual to take a deep breath. If inhalation stops when the area is pressed, this is known as a positive Murphy's sign and is characteristic of acute cholecystitis. An enlarged gallbladder palpated in some cases. Some individuals may have jaundice, a yellowish discoloration of the skin and whites of the eyes (sclerae). Some patients, especially the elderly and diabetics, may have atypical findings. Tests: Blood tests are ordered to determine the white blood cell count (WBC) as an indication of infection; bilirubin, alkaline phosphatase and liver enzymes to evaluate liver function; amylase and lipase to screen for pancreatitis; C-reactive protein, and erythrocyte sedimentation rate (ESR) to check for signs of inflammation; and urinalysis to rule out renal colic. Nevertheless, laboratory tests can be normal in some cases. Pregnancy testing should be considered in women of childbearing age. X-ray is commonly obtained in the absence of pregnancy to help the physician rule out other conditions such as gallbladder cancer (calcified or porcelainized gallbladder), intestinal obstruction, or renal stones. Transabdominal ultrasound (TUS) will likely be performed to visualize the gallbladder and determine the presence of gallstones. This imaging technique has high specificity (98%) for diagnosing cholecystitis (Caddy). TUS may also show thickening of the gallbladder wall, stretching (distention) of the gallbladder, and the presence of gallbladder sludge. If ultrasound is not diagnostic, hepatobiliary scintigraphy (hepatoiminodiacetic acid [HIDA] scan) may be used to examine the cystic duct for possible obstruction This test is 95% accurate in diagnosing acute cholecystitis (Gladden). CT or MRI may be requested as well to confirm the diagnosis or rule out other conditions, especially if ultrasound and HIDA are inconclusive. |
Source: Medical Disability Advisor