Original Article

Association of Clinical and Laboratory Variables With Ultrasound Findings in Right Upper Quadrant Abdominal Pain

Authors: Lisa D. Mills, MD, Trevor Mills, MD, Barbara Foster, PHD

Abstract

Background: The purpose of this study was to determine how laboratory values and physical examination findings correlate with ultrasound findings in the setting of right upper quadrant pain.


Methods: Patients undergoing emergent ultrasound for the evaluation of biliary disease between November 1999 and April 2000 were included. Physical examination findings, laboratory data, and ultrasound results were variables. Logistic regression was performed. Ultrasound diagnosis of acute cholecystitis, cholelithiasis, and normal biliary tract were end points. One hundred seventy-seven patients were enrolled.


Results: Forty-two percent were diagnosed with acute cholecystitis, 30.5% with cholelithiasis, and 27.1% with normal biliary tract. Alkaline phosphatase, Murphy sign, white blood cell count, and total bilirubin were statistically significant predictors of acute cholecystitis. A Murphy sign was defined as arrest of inspiration with pressure over the right upper quadrant.


Conclusions: The findings from this study allow clinicians to apply objective significance to laboratory data and physical examination findings in patients with suspected gallstone disease. The data can be applied to create a predictive model.


Key Points


* Alkaline phosphatase, a Murphy sign, an elevated white blood cell count, and an elevated bilirubin are statistically significant predictors of acute cholecystitis.


* With an accurate predictive model, patient disposition can be determined without emergent imaging.


* This facilitates the clinician in determining early disposition of patient and early notification of consultants.

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References

1.Friedman GD, Kannel WB, Dawber TR. The epidemiology of gallbladder disease: observations in the Framingham study. J Chron Dis 1966;19:292–293.
 
2.Moscati RM. Cholelithiasis, cholecystitis, and pancreatitis. Emerg Clin North Am 1996;14:719–737.
 
3.Glasgow RE, Cho M, Hutter MM, Mulvihill S. The spectrum and cost of complicated gallstone disease in California. Arch Surg 2000;135:1021–1027.
 
4.Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg1993;165:399–404.
 
5.Gracie WA, Ransohoff DF. The innocent gallstone is not a myth. N Engl J Med 1982;307:798–800.
 
6.McSherry, Ferstenburg H, Calhoun WF. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 1985;202:59–63.
 
7.Thistle JL, Cleary PA, Lachin JM, et al. The natural history of cholelithiasis. Ann Intern Med1984;101:171–175.
 
8.Toouli J, Wright TA. Gallstones. Med J Aust 1998;169:166–171.
 
9.Rosenthal RJ, Rossi RL, Martin RF. Options and strategies for the management of choledocholithiasis. World J Surg 1998;22:1125–1132.
 
10.Attili AF, DeSantis A, Capri R. The natural history of gallstones: the CREPCO experienceHepatology 1995;21:656–660.
 
11.Barbara L, Sama C, Labate AMM, et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987;7:913–917.
 
12.Kim CK, Yun M, Lim JK, et al. Refinement of the positive predictive value of gall bladder non-visualization after morphine administration for acute cholecystitis based on the temporal pattern of gall bladder duct activity. Clin Nucl Med 2000;25:603–607.
 
13.Barr RG, Agnesi JN, Schaub CR. Acalculous gall bladder disease: a controversial entity and imaging dilemma revisited. Radiology 1997;204:105–111.
 
14.Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994;154:2573–2581.
 
15.Gallagher EJ. Evidence-based evaluation of diagnostic tests. Ann of Emerg Med 1996;28:347–349.
 
16.Engel JM, Deitch EA, Sekkema W. Gall bladder wall thickness: sonographic accuracy and relation to disease. Am J Radiol 1980;134:907–909.
 
17.Marton KI, Doubiliet P. How to image the gall bladder in suspected cholecystitis. Ann Intern Med1988;109:722–729.
 
18.Menezes N, Narson LP, deBeaux AC, et al. Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 2000;87:1176–1181.
 
19.Addison NV, Finan PJ. Urgent and early cholecystectomy for acute gallbladder disease. Br J Surg1988;75:141–143.
 
20.Lainge FC. Diagnostic evaluation of patients with suspected acute cholecystitis. Radiol Clin North Am 1983;21:471–493.