Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of abdominal organs; in this case, gallbladder and liver); first-line method for suspected cholecystitis. [Findings:
- Edematous thickened gallbladder wall with echo-poor rim 3-4 cm long duct connecting the gallbladder to the ductus hepaticus; with/without perivesical fluid; in approximately 90% of cases, there is a temporary extension of the ductus cysticus (3-4 cm long duct connecting the gallbladder to the ductus hepaticus) due to a stone
- Differential diagnoses of gallbladder wall edema: Acute hepatitis (liver inflammation), cirrhosis (“shrinking liver”) with portal hypertension, severe right heart failure (heart failure), severe albumin deficiency; adenomyomatosis (noninflammatory, nontumorous disease of unknown cause that results in gallbladder wall thickening), chronic cholecystitis (gallbladder inflammation), neoplasia (new growth).
- Enlargement of the gallbladder; in chronic recurrent cholecystitis: Porcelain gallbladder, shrinking gallbladder; risk of gallbladder carcinoma (gallbladder cancer).
- Sonographic-palpatory Murphy sign with about 90% accuracy for the diagnosis of acute cholecystitis; the gallbladder is sonographically visited and compressed with a finger under external vision. Murphy’s sign is positive if the patient reports a pain on pressure during this procedure].
- Edematous thickened gallbladder wall with echo-poor rim 3-4 cm long duct connecting the gallbladder to the ductus hepaticus; with/without perivesical fluid; in approximately 90% of cases, there is a temporary extension of the ductus cysticus (3-4 cm long duct connecting the gallbladder to the ductus hepaticus) due to a stone
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Computed tomography (CT) of the abdomen (abdominal CT) – method of first choice in complicated courses.
- Magnetic resonance imaging of the abdomen (abdominal MRI).
- Indicated in complicated courses
- In children: MRI/MRCP (magnetic resonance cholangiopancreaticography (MRCP)) in case of complications/misformations (e.g., choledochal cyst).
- Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument)). – Suspected microlithiasis (multiple, 1-3 mm stones).
- Gallbladder scintigraphy (procedure of nuclear medicine) – highest diagnostic accuracy for the detection of acute cholecystitis; procedure is clinically meaningless in Germany!
