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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 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.

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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
Abdominal Rigidity Edit 11%87%

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
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
Anorexia Edit 65%50%

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
Elevated Serum Transaminases Edit 38%62%

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 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
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
Emesis Edit 71%53%

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
Epigastric Pain Edit No accuracy specified.

Study: no study specified.
Guarding Edit 45%70%

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
hearing loss Edit 35%80%

>35 C

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
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
Leukocytosis Edit 63%57%

>10k/ul

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
Murphy sign Edit 65%87%

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
Rectal tenderness Edit 8%82%

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
RUQ Pain Edit 81%67%

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
Ultrasound Edit No accuracy specified.

Study: no study specified.

 

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