Gallstone disease diagnostic study of choice
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The best modality for detecting gallstones is a transabdominal ultrasound (TAUS). Patients who present with right upper quadrant pain are suspected of having gallstone disease. The patients symptoms are usually accompanied by a normal physical examination and normal laboratory results including those for leukocytosis and pancreatic enzyme levels. In obese patients, or patients where imaging is practically difficult an esophageal ultrasound (EUS) with high sensitivity may be used.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Transabdominal ultrasound (TAUS) is the gold standard test for the diagnosis of gallstone disease.
- The following result of transabdominal ultrasound is confirmatory of gallstone disease:
- The transabdominal ultrasound should be performed when:
- Among patients who present with clinical signs of gallstone disease, the transabdominal ultrasound is the most specific test for the diagnosis.
- Gallstones appear as echogenic foci that cast an acoustic shadow and exhibit gravitational dependence.
- Gravel has a similar appearance to stones and are also echogenic and cast shadows.
- Sludge is echogenic but does not cast shadows.
The comparison table for diagnostic study of choice for gallstone disease
- Solitary or multiple stones in the gallbladder or another site within the biliary tree.
- Sludge or gravel seen within the gallbladder.
Sequence of Diagnostic Studies
The transabdominal ultrasound should be performed when:
- The patient presented with symptoms/signs of biliary colic or jaundice or fever as the first step of diagnosis.
- A positive result is the visualization of stones in the patient.
- There is no particular established diagnostic criteria for gallstone disease.
- Diagnosis is based upon history, symptoms and possibly, gallstone detection with transabdominal ultrasound.
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