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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).

[Edit Diagnosis] [Merge dx] [Add prevalence]

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.

Blood Test

Finding +LR-LR Comments, Study
Elevated Alkaline Phosphatase Edit 0.91.1

>120U/L

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Serum Transaminases Edit 11

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Total Bilirubin Edit 1.20.9

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 1.20.7

(any one elevated)

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Leukocytosis Edit 1.50.6

>10k/ul

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

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

Combination of Tests

Finding +LR-LR Comments, Study
Elevated Total Bilirubin, AST, and Alk Phos Edit 1.70.8

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 1.20.7

(any one elevated)

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Leukocytosis and fever Edit 1.60.9

Leukocytosis is >10k/ul

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

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

History

Finding +LR-LR Comments, Study
Anorexia Edit 1.30.7

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Emesis Edit 1.50.5

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Pain Edit 2.50.3

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

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

Imaging

Finding +LR-LR Comments, Study
Abdominal CT Edit 101.90.1

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 Edit 4.40.2

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
HIDA scan Edit 9.70

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
Ultrasound Edit No accuracy specified.

Study: no study specified.

Physical Exam

Finding +LR-LR Comments, Study
Abdominal Rigidity Edit 0.81

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Guarding Edit 1.50.8

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
hearing loss Edit 1.80.8

>35 C

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Murphy sign Edit 50.4

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Rebound Edit 0.91

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Rectal tenderness Edit 0.41.1

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Mass Edit 1.11

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Tenderness Edit 1.70.4

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

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

Renal

Finding +LR-LR Comments, Study
hearing loss Edit 1.80.8

>35 C

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

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

Vital Signs

Finding +LR-LR Comments, Study
hearing loss Edit 1.80.8

>35 C

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

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

Untagged

Finding +LR-LR Comments, Study
Epigastric Pain Edit No accuracy specified.

Study: no study specified.

 

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