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 Physical Exam Tag this Diagnosis.

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

Blood Test

Finding	Sensitivity	Specificity	Comments, Study
Elevated Alkaline Phosphatase	45%	52%	>120U/L Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Serum Transaminases	38%	62%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Total Bilirubin	45%	63%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Total Bilirubin, AST, or Alk Phos	70%	42%	(any one elevated) Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Leukocytosis	63%	57%	>10k/ul Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Combination of Tests

Finding	Sensitivity	Specificity	Comments, Study
Elevated Total Bilirubin, AST, and Alk Phos	34%	80%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Elevated Total Bilirubin, AST, or Alk Phos	70%	42%	(any one elevated) Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Leukocytosis and fever	24%	85%	Leukocytosis is >10k/ul Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

History

Finding	Sensitivity	Specificity	Comments, Study
Anorexia	65%	50%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Emesis	71%	53%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Pain	81%	67%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Imaging

Finding	Sensitivity	Specificity	Comments, Study
Abdominal CT	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
Abdominal US	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
HIDA scan	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
Ultrasound	No accuracy specified.		Study: no study specified.

Physical Exam

Finding	Sensitivity	Specificity	Comments, Study
Abdominal Rigidity	11%	87%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Guarding	45%	70%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
hearing loss	35%	80%	>35 C Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Murphy sign	65%	87%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Rebound	30%	68%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Rectal tenderness	8%	82%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Mass	21%	80%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
RUQ Tenderness	77%	54%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80