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Cholecystitis: Sensitivity and Specificity

Introduction: Cholecystitis is an acute infection of the gallbladder almost universally because of obstruction by gallstones (Cholelithiasis), though the entity of acalculous cystitis exists (often in the context of hypotension and shock).

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Tags: Gastrointestinal Problem Hepatic Infection Tag this Diagnosis.

The sensitivity and specificity of findings for Cholecystitis are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding SensitivitySpecificity Comments, Study
Abdominal CT Edit 91.7%99.1%

75 patients retrospectively (comparing acute chole, acute gangrenous chole, and no cholecystitis)

Study: AJR Am J Roentgenol. 2002 Feb;178(2):275-81. PMID: 11804880

HIDA scan Edit 97%90%

HIDA (hydroxyminodiacetic acid) scan in cholecystitis shows the liver by the isotope, but the gallbladder is not seen indicates an obstructed cystic duct.

Study: Arch Intern Med 1994 Nov 28;154(22):2573-81. PMID 7979854

Specific Findings

Finding SensitivitySpecificity Comments, Study
Murphy sign Edit 65%87%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Abdominal Rigidity Edit 11%87%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Leukocytosis and fever Edit 24%85%

Leukocytosis is >10k/ul

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Abdominal US Edit 88%80%

note that accuracy of US for detecting gallstones is sens=84%,spec=99%.

Study: Arch Intern Med 1994 Nov 28;154(22):2573-81. PMID 7979854

Negative Findings

Finding SensitivitySpecificity Comments, Study
Abdominal Rigidity Edit 11%87%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Rectal tenderness Edit 8%82%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Rebound Edit 30%68%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Elevated Alkaline Phosphatase Edit 45%52%

>120U/L

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Fever Edit 35%80%

>35 C

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Elevated Total Bilirubin, AST, and Alk Phos Edit 34%80%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

RUQ Mass Edit 21%80%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Guarding Edit 45%70%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

RUQ Pain Edit 81%67%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Elevated Total Bilirubin Edit 45%63%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Elevated Serum Transaminases Edit 38%62%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Leukocytosis Edit 63%57%

>10k/ul

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

RUQ Tenderness Edit 77%54%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Emesis Edit 71%53%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Anorexia Edit 65%50%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Elevated Total Bilirubin, AST, or Alk Phos Edit 70%42%

(any one elevated)

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80

Nausea Edit 77%36%

Study: JAMA. 2003;289:80-86.

http://jama.ama-assn.org/cgi/content/full/289/1/80