The Rational Clinical Examination
David L. Simel, Drummond Rennie
Acute Cholecystitis
Robert L. Trowbridge, Kaveh G. Shojania, Amy Rosenthal
Make the Diagnosis: Acute Cholecystitis
Topics Discussed:
cholecystitis, acute, criterion standard comparisons (diagnostic tests), likelihood ratio, make the diagnosis, prior probability
Excerpt:
"No single clinical finding, or known combination of clinical
history and physical examination findings, efficiently establishes
a diagnosis of acute cholecystitis. Thus, clinicians must rely on
their clinical gestalt. Bedside ultrasonography requires additional
study, and clinicians must receive proper training, followed by demonstration
of their proficiency.Approximately 5% of emergency department patients with
abdominal pain have cholecystitis. Women and Native Americans have
a higher risk of cholecystitis. Patients with increased risk of
cholecystitis include those with chronic hemolytic disease (eg,
sickle cell disease) or recent rapid weight loss...."
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