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Acute cholecystitis: diagnosis
Last reviewed: 23.04.2024
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Plan of examination for suspected acute cholecystitis
The diagnosis of acute cholecystitis should be suspected in the presence of typical pains (colic colic) in combination with the results of physical, laboratory and instrumental methods of examination (ultrasound, PHAGS, X-ray study).
Laboratory diagnostics of acute cholecystitis
Compulsory laboratory tests
- Clinical blood test: leukocytosis, a moderate shift of the leukocyte formula to the left, an increase in ESR.
- Blood serum glucose.
- Total protein and protein fractions.
- Serum cholesterol.
- Bilirubin and its fractions: with acute cholecystitis a slight increase is possible.
- Aspartate aminotransferase (ACT), alanine aminotransferase (ALT): activity may be increased.
- Gamma-Glutamyltranspeptidase: its activity can be increased in the framework of cholestasis syndrome in combination with an increase in the activity of alkaline phosphatase (APF).
- Alkaline phosphatase.
- Amylase of blood serum: significantly exceeding 2 times or more, which is important in carrying out a differential diagnosis and is most often associated with pancreatitis when the stone is infringed in the large duodenal papilla.
- General urine analysis.
Instrumental diagnostics of acute cholecystitis
Compulsory instrumental research
- Ultrasound of the abdominal cavity organs: on the background of cholelithiasis, concrements, thickening of the gallbladder wall (more than 3 mm), duplication of the contour of the wall of the gallbladder, accumulation of fluid near it. Possible pristenochnaya inhomogeneity associated with inflammatory changes in the mucous membrane, the imposition of fibrin, inflammatory detritus. With empyema of the gallbladder, a middle echogenicity of the structure without an acoustic shade (pus) is detected in its cavity.
- FEGDS are performed in order to exclude peptic ulcer as a possible cause of pain syndrome; it is necessary to examine the large duodenal papilla.
- X-ray examination of chest organs to exclude pathology of the lungs and pleura.
Additional research methods
- Computer tomography as an alternative to ultrasound.
- MRI of the biliary tract.
- Endoscopic retrograde cholangiopancreatography (ERCPG) for the exclusion of choledocholithiasis, as well as for suspected tumor nature of the lesions of the biliary tract.
Differential diagnosis
Acute cholangitis is clinically characterized by the Charcot triad (pain in the upper right quadrant of the abdomen, fever, jaundice) or Raynaud's pentad (Charcot's triad + arterial hypotension and impaired consciousness). The activity of ALT and ACT can reach 1000 U / l.
Acute appendicitis, especially with a high location of the cecum.
Acute pancreatitis: pain in the epigastric region, radiating in the back, nausea, vomiting, increased activity in the blood of amylase and lipase are characteristic.
Right-sided pyelonephritis: tenderness in palpation of the right rib-vertebral angle, signs of a urinary tract infection.
Peptic ulcer of the stomach and duodenum: pain in the right subcostal or epigastric region; complicated by perforation, the ulcer may resemble acute cholecystitis in clinical manifestations.
Other diseases: pathology of the lungs and pleura, acute viral hepatitis, acute alcoholic hepatitis, lower diaphragmatic myocardial infarction, ischemia in the mesenteric pool, gonococcal perihepatitis, abscess or liver tumor.
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