Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of abdominal organs; in this case, gallbladder and liver); first-line method for suspected cholelithiasis (gallstones). [Findings:
- Cholelithiasis: sensitivity (percentage of diseased patients in whom the disease is detected by use of the procedure, i.e., a positive finding occurs) for detection of gallbladder stone is reported to be 98%; stones in the gallbladder show up as an anechoic reflex with typical dorsal (“backward”) acoustic shadow; stones in the bile ducts cause dilatation of the choledochal duct (common bile duct) and the intrahepatic bile ducts
- Cholecystitis (gallbladder inflammation):
- Edematous thickened gallbladder wall with echo-poor rim; with/without perivesical fluid; calculi are usually detectable
- Differential diagnoses of gallbladder wall edema: Acute hepatitis (liver inflammation), cirrhosis (“shrunken liver”) with portal hypertension, severe right heart failure (cardiac insufficiency), severe albumin deficiency; adenomyomatosis (noninflammatory, nontumorous disease of unknown cause that results in gallbladder wall thickening), chronic cholecystitis (gallbladder inflammation), neoplasia (new growth)
- 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; with/without perivesical fluid; calculi are usually detectable
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Level II of diagnostics (both subsequent procedures are equivalent in choledocholithiasis (presence of stones in the bile ducts) with sensitivity and specificity above 90%)::
- Magnetic resonance cholangiopancreatography (MRCP) – first-line method for suspected bile duct stones; not suitable for stones <3 mm.
- 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).
- Computed tomography (CT) of the abdomen (abdominal CT) – method of first choice in complicated courses, ie, complications, such as gallbladder empyema, abscesses in the gallbladder bed or perforation.
- Endoscopic retrograde cholangiopancreatography (ERCP; endoscopic procedure used to perform diagnostic and therapeutic procedures. In addition to imaging the pancreatic duct, bile ducts and gallbladder with X-ray contrast medium, stones can also be removed or the opening of the bile duct (papilla vateri) can be dilated) – indicated with simultaneous therapeutic intent
