Focused ultrasound sensitivity for the detection of gallstones is about 86% in the hands of a trained emergency physician sonographer. Specificity is 97%. Negative predictive value (meaning if it's a negative scan, you can hang your hat that it IS negative- like a d-dimer) is 92%.

Sensitivity and specificity for detection of cholelithiasis is 91% and 97% respectively.

Normal Anatomy



Cholecystitis

Cholecystitis is an acute inflammation of the gallbladder which may be calculous (with gallstones) or acalculous (without -5%). Historical features include colicky abdominal pain associated with fever, tachycardia, RUQ or epigastric tenderness, usually after consuming a fatty meal. Early cholecystitis presents in a visceral pain fashion (i.e. dull and difficult to localize). As the common bile duct (CBD) is progressively distended from blockage, pain becomes more localizable.

Acalculous cholecystitis is frequently seen in post-partum or post-op patients, patients with major trauma or burns, patients with vasculopathy, in diabetics, and in those who carry diagnoses of CHF or sepsis. The elderly are at an increased risk of developing the disease. Gangrene of the gallbladder and perforation are more common than in calculous cholecystitis.

Emphysemataous cholecystitis (very grave) occurs when gas forming organisms (E coli, clostridium, klebsiella, or anaerobic strep) inhabit the gallbladder.

Gallstone ileus, an uncommon variant of hepatobiliary disease, occurs when a large gallstone erodes into the duodenum, travels to the distal ileum and produces obstruction. It is usually seen in elderly women with a preexisting history of gallstones. Pneumobilia may accompany the diagnosis.