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A diagnostic workup is based on the most likely diagnosis. In testing for gallbladder disease, specifically, liver panel tests and pancreatic enzymes such as lipase will be within normal limits. There can be a mild elevation in alkaline phosphatase and bilirubin in some instances, such as cholecystitis.
Cholescintigraphy or hepatobiliary scintigraphy is scintigraphy of the hepatobiliary tract, including the gallbladder and bile ducts.The image produced by this type of medical imaging, called a cholescintigram, is also known by other names depending on which radiotracer is used, such as HIDA scan, PIPIDA scan, DISIDA scan, or BrIDA scan.
Murphy's sign has a high sensitivity and negative predictive value, although the specificity is not high. [2] However, in the elderly the sensitivity is markedly lower; a negative Murphy's sign in an elderly person is not useful for ruling out cholecystitis if other tests and the clinical history suggest the diagnosis.
Once tissue has died, the gallbladder is at greatly increased risk of rupture (perforation), which can cause sharp pain. Rupture can also occur in cases of chronic cholecystitis. [13] Rupture is a rare but serious complication that leads to abscess formation or peritonitis. [14] Massive rupture of the gallbladder has a mortality rate of 30%. [13]
The CCK test may be administered in conjunction with an ultrasound test to visually monitor gall bladder contraction. While the test is usually administered in a supine position Dr. William Smedley of Wilkes Barre, Pennsylvania has detected previously missed gallbladder abnormalities by administering the test in an erect position. [2] [3] [4]
It can also diagnose choledochal cysts very reliably. [5] Besides providing information regarding the biliary system, MRCP also provides information regarding surrounding solid organs and blood vessels, thus useful for planning the resection of pancreatic cancer and look for complications of primary sclerosing cholangitis such as liver ...
The diagnosis is confirmed with either a magnetic resonance cholangiopancreatography (MRCP), an endoscopic retrograde cholangiopancreatography (ERCP), or an intraoperative cholangiogram. If the patient must have the gallbladder removed for gallstones, the surgeon may choose to proceed with the surgery, and obtain a cholangiogram during the surgery.
The IVC has been largely replaced by other diagnostic procedures—by ERCP (endoscopic retrograde cholangiopancreatography), endoscopic ultrasound and, increasingly, by MRI cholangiography, none of which are affected by jaundice. It is sometimes used when ERCP is unsuccessful.