Assessment of Gallbladder Aetiology

Clinical Features to Assess

The World Journal of Emergency Surgery recommends that right upper quadrant pain or tenderness is the most consistent finding in gallbladder disease, with a positive likelihood ratio associated with Murphy's sign 1, 2
Fever indicates an inflammatory process, and nausea, vomiting, or food intolerance are common associated symptoms in patients with gallbladder disease 1, 2, 3
A palpable gallbladder mass suggests advanced or complicated disease, while jaundice raises concern for common bile duct involvement or cholangitis 3, 4

The World Journal of Emergency Surgery suggests that a complete blood count (CBC) with differential is essential, as an elevated white blood cell count is a key inflammatory marker, and neutrophil count specifically has the strongest laboratory association with acute cholecystitis 1, 2, 5
C-reactive protein (CRP) is elevated in gallbladder inflammation, and liver function tests (LFTs) assess for biliary obstruction 1, 2, 6
Total and direct bilirubin levels are elevated in bile duct involvement, and alkaline phosphatase and GGT are indicators of biliary stasis 4, 6, 7

Abdominal ultrasound is the initial imaging modality of choice with high sensitivity for gallstones, gallbladder wall thickening, and pericholecystic fluid 4
CT scan with IV contrast has high sensitivity for acute cholecystitis, particularly useful for complications, and HIDA scan is the most sensitive overall imaging modality for cholecystitis 4

Patients must be stratified for common bile duct stone risk using clinical, laboratory, and imaging findings combined, with high-risk patients requiring preoperative ERCP and moderate-risk patients needing second-level examinations 2

No single laboratory test or physical examination finding has sufficient diagnostic power to establish or exclude acute cholecystitis definitively, and combination with clinical and imaging findings is mandatory 1, 6
Immunocompromised status may present atypically with minimal physical findings despite severe inflammation, and overlooking these patients can lead to missed diagnoses 3