Friday, January 30, 2015

The most sensitive and specific test to confirm the diagnosis of acute cholecystitis is:

The most sensitive and specific test to confirm the diagnosis of acute cholecystitis is:


biliary system

a. Oral cholecystogram.
b. HIDA radioisotope scan.
c. Ultrasound.
d. Plain film of the abdomen.
e. The triad of fever, elevated bilirubin, and elevated alkaline phosphatase.




The answer is b. Ultrasonography has an unadjusted 94% sensitivity and 78% specificity for the diagnosis of acute cholecystitis. The 50% sensitivity of CT scanning is insufficient for it to be used in place of ultrasonography.

Technetium-iminoacetic acid analogue-based radioisotope scintigraphy (HIDA) has 97% sensitivity and 90% specificity. Within 1 hour of injection, a normal patient will have a clearly outlined gallbladder and cystic duct. Failure to demonstrate the gallbladder within this time frame is consistent with cystic duct obstruction.

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