Cholecystitis: Likelihood Ratios

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 Physical Exam Tag this Diagnosis.

The likelihood ratios of findings for Cholecystitis are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
HIDA scan	9.7	0	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
Abdominal CT	101.9	0.1	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
Abdominal US	4.4	0.2	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
RUQ Pain	2.5	0.3	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Murphy sign	5	0.4	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Good Negative Likelihood Ratio

RUQ Tenderness

1.7

0.4

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

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

Negative Findings

Rectal tenderness

0.4

1.1

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

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

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Abdominal Rigidity	0.8	1	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Leukocytosis and fever	1.6	0.9	Leukocytosis is >10k/ul Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
hearing loss	1.8	0.8	>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	1.7	0.8	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Mass	1.1	1	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Guarding	1.5	0.8	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Rebound	0.9	1	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Total Bilirubin	1.2	0.9	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Serum Transaminases	1	1	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Leukocytosis	1.5	0.6	>10k/ul Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Emesis	1.5	0.5	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Alkaline Phosphatase	0.9	1.1	>120U/L Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Anorexia	1.3	0.7	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Total Bilirubin, AST, or Alk Phos	1.2	0.7	(any one elevated) Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Findings With Unspecified Accuracy

Ultrasound

No accuracy specified.

Study: no study specified.

Epigastric Pain

No accuracy specified.

Study: no study specified.