Obtain a chemistry panel, including electrolytes, liver enzymes, and bilirubin.
Choledocholithiasis can manifest only with elevation of serum alkaline phosphatase
Nearly 50% of patients with symptomatic gallstone disease will have abnormal transaminases.
A complete blood count is obtained routinely in patients suspected of cholelithiasis.
CBC might serve as a preoperative lab test normally obtained in patients undergoing major surgery, such as laparoscopic cholecystectomy.
An elevated white blood cell count alerts the clinician to the possibility of acute cholecystitis, a condition requiring more urgent treatment.
Serum lipase and amylase levels are helpful in cases of diagnostic uncertainty or suspected concurrent pancreatitis.
Coagulation parameters measured by prothrombin (PT) and partial thromboplastin time (PTT) might be abnormal in the severely jaundiced patient due to dysfunction in vitamin K absorption. These tests are routinely ordered preoperatively, especially in patients who are medically anticoagulated with warfarin .
Upright and supine abdominal radiographs are useful.
Approximately 15% of gallstones are radiopaque and can be seen on plain x-ray.
A porcelain gallbladder (heavily calcified) should be removed surgically because of increased risk of gallbladder cancer.
Other causes of abdominal pain diagnosed with the assistance of x-rays include perforated viscus, bowel obstruction, calcific pancreatitis, and renal stones.
Ultrasound (US) is the most sensitive and specific test for the detection of gallstones.
US provides information about the size of the common bile duct and hepatic duct and the status of liver parenchyma and the pancreas.
Thickening of the gallbladder wall and presence of pericholecystic fluid are radiographic signs of acute cholecystitis.
Computerized tomography scanning
CT scanning often is used in workup of abdominal pain without specific localizing signs or symptoms.
CT scanning is not a first-line study for detection of gallstones because of greater cost and invasive nature of the test.
When present, gallstones usually are seen on CT scan.
99mTc-image display and analysis scintigraphy scan
99mTc-image display and analysis (IDA) scintigraphy (HIDA) scan does not detect gallstones.
HIDA scan identifies an obstructed gallbladder (eg, gallstone impacted in the neck of the gallbladder).
HIDA scan is the most sensitive and specific test for acute cholecystitis.
A poorly contracting gallbladder (biliary dyskinesia) might cause the patientís symptoms, and HIDA scan makes the diagnosis.
Acute acalculous cholecystitis is diagnosed most accurately with HIDA scan.
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