Preliminary Diagnosis: Cholecystitis
I. What imaging technique is first-line for this diagnosis?
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Ultrasound
II. Describe the advantages and disadvantages of this technique for diagnosis of cholecystitis.
Advantages
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Relatively inexpensive
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Quick
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Does not use ionizing radiation
Disadvantages
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Difficult to assess gallbladder if patient just ate or gallbladder is contracted
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Difficult to assess if patient has a large body habitus
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Results dependent on ability of patient to cooperate during the exam and sonographer’s skill
III. What are the contraindications for the first-line imaging technique?
No contraindications
IV. What alternative imaging techniques are available?
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Hepatobiliary scintigraphy
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CT of the abdomen and pelvis with or without contrast
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MRI
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ERCP
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cholecystitis.
Hepatobiliary scintigraphy
Advantage
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Excellent sensitivity and specificity for the diagnosis of cholecystitis
Disadvantages
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More expensive than ultrasound
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Requires more patient cooperation than ultrasound
CT of the abdomen and pelvis with or without contrast
Advantages
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Findings consistent with cholecystitis, such as fat stranding, are easily seen
Disadvantages
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Exposure to ionizing radiation
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More expensive than ultrasound
MRI
Advantages
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Findings consistent with cholecystitis, including stones, are easily seen.
Disadvantages
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Significantly more expensive than ultrasound
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Time consuming
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Requires significant patient cooperation to minimize artifact
ERCP
Advantages
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Can see filling of gallbladder and may document common bile duct (CBD) stones in patients with associated cholangitis
Disadvantage
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Invasive test and has significant risk of associated complications
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More expensive than ultrasound
VI. What are the contraindications for the alternative imaging techniques?
Hepatobiliary scintigraphy
Relative contraindication in pregnancy
CT of the abdomen and pelvis with or without contrast
Relative contraindication in pregnancy
MRI
Absolute contraindication in those with non-MR-compatible hardware
ERCP
Relative contraindication in pregnancy
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