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Cracking the Code: How Doctors Diagnose Acalculous Cholecystitis
Published: May 07, 2024
Diagnosing acalculous cholecystitis can be like solving a medical mystery. This article explores the tests doctors use to uncover this sneaky gallbladder condition.
The Ultrasound: First Line of Defense
Ultrasound is usually the go-to test for suspected acalculous cholecystitis. It's quick, non-invasive, and can be done at the bedside. Doctors look for telltale signs like a thickened gallbladder wall (over 3.5mm), fluid around the gallbladder, or a sonographic Murphy's sign (pain when the probe presses on the gallbladder during breathing).
CT Scan: The Detailed View
When ultrasound results are unclear, a CT scan may be ordered. This provides a more detailed look at the gallbladder and surrounding tissues. Signs of acalculous cholecystitis on CT can include gallbladder wall thickening, inflammation around the gallbladder, or even gas in the gallbladder wall in severe cases.
HIDA Scan: The Functional Test
A hepatobiliary iminodiacetic acid (HIDA) scan is a nuclear medicine test that shows how well the gallbladder is functioning. A radioactive tracer is injected and should normally appear in the gallbladder within an hour. If it doesn't, this suggests blockage or inflammation consistent with acalculous cholecystitis.
Putting the Pieces Together
Diagnosing acalculous cholecystitis isn't just about one test result. Doctors consider the patient's symptoms, risk factors, lab tests (like elevated white blood cell count), and imaging findings together. Sometimes, a combination of tests is needed to make a definitive diagnosis.
Frequently Asked Questions
No, acalculous cholecystitis is typically diagnosed with imaging and clinical findings.
Each test has strengths and limitations; combining tests improves accuracy.
Blood tests support diagnosis but aren't specific enough alone.
Ultrasound and CT are quick; HIDA scans can take several hours.
Most are painless, though some may cause mild discomfort.
The Diagnostic Toolkit
While challenging, a combination of clinical assessment and imaging tests allows doctors to accurately diagnose acalculous cholecystitis.
References
- Mariat G, Mahul P, Prév t N, et al. Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients. Intensive Care Med 2000; 26:1658.
- Mirvis SE, Vainright JR, Nelson AW, et al. The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. AJR Am J Roentgenol 1986; 147:1171.
- Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA 2003; 289:80.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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