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.

Sensitive and Specific Findings

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

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

Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Murphy sign	65%	87%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Abdominal Rigidity	11%	87%	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

Sensitive Findings

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

Negative Findings

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
Rectal tenderness	8%	82%	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
Elevated Alkaline Phosphatase	45%	52%	>120U/L Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
hearing loss	35%	80%	>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	34%	80%	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
Guarding	45%	70%	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
Elevated Total Bilirubin	45%	63%	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
Leukocytosis	63%	57%	>10k/ul 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
Emesis	71%	53%	Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
Anorexia	65%	50%	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

Findings With Unspecified Accuracy

Ultrasound

No accuracy specified.

Study: no study specified.

Epigastric Pain

No accuracy specified.

Study: no study specified.