How is acute cholecystitis diagnosed?

Acute cholecystitis is diagnosed through a combination of medical history assessment, physical examination, and diagnostic tests. Here are the main methods used for diagnosing acute cholecystitis:

  1. Medical history and physical examination: The healthcare provider will ask about your symptoms, including the location and nature of the pain, its duration, and any associated symptoms like nausea or vomiting. They will also perform a physical examination, checking for tenderness in the abdomen, especially in the right upper quadrant.
  2. Blood tests: Blood tests can help evaluate the severity of inflammation and infection. The following blood tests are commonly performed:a. Complete blood count (CBC): Elevated white blood cell count may indicate an infection.b. Liver function tests (LFTs): These tests assess liver enzymes and bilirubin levels, which can be affected if the common bile duct is obstructed or if there are complications.c. C-reactive protein (CRP): Elevated CRP levels indicate inflammation.
  3. Imaging studies: Various imaging techniques are used to visualize the gallbladder and detect any abnormalities. These include:a. Ultrasound: Ultrasound is often the initial imaging modality of choice. It can reveal gallstones, thickening of the gallbladder wall, or the presence of fluid surrounding the gallbladder, indicating inflammation.b. HIDA scan: A hepatobiliary iminodiacetic acid (HIDA) scan involves injecting a radioactive tracer that is taken up by the liver and excreted into the bile. It helps assess the function of the gallbladder and can determine if it is obstructed or not functioning properly.c. CT scan: A computed tomography (CT) scan may be performed to evaluate the gallbladder and surrounding structures, especially if there are complications or if the diagnosis is uncertain based on other tests.
  4. Other diagnostic procedures: In some cases, additional procedures may be needed to confirm the diagnosis or assess for complications. These may include:a. Endoscopic retrograde cholangiopancreatography (ERCP): ERCP involves the insertion of a flexible tube through the mouth, esophagus, and stomach to access the bile ducts. It can help visualize any blockages or abnormalities in the bile ducts.b. Magnetic resonance cholangiopancreatography (MRCP): MRCP is a non-invasive imaging technique that uses magnetic resonance imaging (MRI) to produce detailed images of the bile ducts and gallbladder.
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The healthcare provider will evaluate the results of these diagnostic tests to make a definitive diagnosis of acute cholecystitis and determine the appropriate treatment plan.