Acute cholecystitis is a diagnosis that we make frequently in the Emergency Department. But like all diagnostic work ups there is a lot to know about which parts of the history, examination and bedside tests we can do in the ED that really help either rule in or rule out the disease.

In this podcast we run through some of the key bits of information published in the Commissioning Guide Gallstone disease 2016, jointly published by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland & the Royal College of Surgeons.

We then concentrate on a recent systematic review of the diagnostic work up for Acute Cholecystitis. Yet again the evidence base brings up some issues to challenge our traditional teaching on the topic but should help polish our management of patients with a differential of Acute Cholecystitis.

Here are some of the key findings from the paper;

Finding LR + LR –
Fever (0.74-1.24) (0.76-1.49)
Jaundice (0.80-13.81) (0.87-1.03)
Murphy’s 15.64 (11.48-21.31) 0.40 (0.32-0.50)
RUQ pain (0.92-14.02) (0.46-7.86)
Elevated bilirubin 5.80 (1.25-26.99) 0.64 (0.39-10.8)
Ultrasound (performed & interpreted by the ED physician) 3.23 (1.74-6.0) 0.18 (0.10-0.33)


References & Further Reading

Commissioning Guide Gallstone disease 2016

Up to date; Acute Cholecystitis

NICE guidance; Acute Cholecystitis

History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis. Jain A. Acad Emerg Med

TheNNT; likelihood ratios


  • Kathryn Duffy says:

    In terms of ED US – are the LRs stated relating to simply presence/abscence of gallstones or more cholecystitis-specific features such as peri cholecystic fluid or thickened GB wall?

    • Simon Laing says:

      Not explicit in the paper, but likely to be heterogeneous in their approach (but no acalculous cases included)

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