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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).

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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.

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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 Rigidity Edit 0.81

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

http://jama.ama-assn.org/cgi/content/full/289/1/80
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
Anorexia Edit 1.30.7

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

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

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 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
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
Leukocytosis Edit 1.50.6

>10k/ul

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
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 Pain Edit 2.50.3

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
Ultrasound Edit No accuracy specified.

Study: no study specified.

 

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