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Gastrointestinal Emergencies pp 237–240Cite as

How Should I Image the Patient with Suspected Liver or Biliary Disease?

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Abstract

Patients with right upper quadrant pain presenting for emergency care frequently require imaging. Understanding the pros and cons of the potential imaging modalities is key to appropriate evaluation and management. Ultrasound is often recommended as the initial test of choice in these patients. Ultrasound excels when evaluating for cholelithiasis and cholecystitis. Computerized tomography is considered second line but is frequently employed in equivocal cases. Understanding limitations and pitfalls of these studies is imperative.

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References

  1. Yarmish GM, Smith MP, Rosen MP, et al. ACR appropriateness criteria right upper quadrant pain. J Am Coll Radiol. 2014;11:316–22.

    Article  Google Scholar 

  2. Ross M, Brown M, McLaughlin K, Atkinson P, Thompson J, Powelson S, Clark S, Lang E. Emergency physician-performed ultrasound to diagnose cholelithiasis: a systemic review. Acad Emerg Med. 2011;18:227–35.

    Article  Google Scholar 

  3. Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, Sinert R. History, physical examination, laboratory testing, and emergency department. Ultrasonography for the diagnosis of acute cholecystitis. Acad Emerg Med. 2017;24(3):281–97.

    Article  Google Scholar 

  4. Bisset RA, Khan AN. Differential diagnosis in abdominal ultrasound, vol. 202. Long: WB Saunders. p. 159–80.

    Google Scholar 

  5. Scott MA, Farrands PA, Guyer PB, et al. Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound. 1991;19:73–6.

    Article  Google Scholar 

  6. Dong B, Chen M. Improved sonographic visualization of choledocholithiasis. J Clin Ultrasound. 1987;15:185–90.

    Article  CAS  Google Scholar 

  7. Gurusamy KD, Giljaca V, Takwoingi Y, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015;2:1–57.

    Google Scholar 

  8. Lal N, Mehra S, Lal V. Ultrasonographic measurement of normal common bile duct diameter and its correlation with age, sex and anthropometry. J Clin Diagn Res. 2014;8:AC01–4.

    PubMed  PubMed Central  Google Scholar 

  9. Lee DH, Ahn YJ, Lee HW, et al. Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis. Ann Surg Treat Res. 2016;91:239–46.

    Article  Google Scholar 

  10. Thurley PD, Dhingsa R. Laparoscopic cholecystectomy: post-operative imaging. Am J Roentgenol. 2008;191:794–801.

    Article  Google Scholar 

  11. Kimura Y, Takada T, Kawarada Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepato-Biliary-Pancreat Surg. 2007;14:15–26.

    Article  Google Scholar 

  12. Amitrano L, Guardascione MA, Brancaccio V, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40:736–41.

    Article  Google Scholar 

  13. Altemeier WA, Culbertson WR, Fullen WD, et al. Intra-abdominal abscesses. Am J Surg. 1973;125:70–9.

    Article  CAS  Google Scholar 

  14. Bloom AA, Remy P. Emphysematous cholecystitis. Medscape 2015 https://emedicine.medscape.com/article/173885. Accessed 20 Dec 2017.

  15. Paulson EK. Acute cholecystitis: CT findings. Semin Ultrasound CT MR. 2000;21:56–63.

    Article  CAS  Google Scholar 

  16. Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology. 2012;264:708–20.

    Article  Google Scholar 

  17. Sorenson MK, Fancher S, Lang NP, Eidt JF, Broadwater JR. Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia. Am J Surg. 1993;166:672–4.

    Article  CAS  Google Scholar 

  18. Mahid SS, Jafri NS, Brangers BC, Minor KS, Hornung CA, Galandiuk S. Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. 2009;144:180–7.

    Article  Google Scholar 

  19. Aube C, Delorme B, Yzet T, et al. MR cholangiopancreatography versus endoscopic sonography in suspected common bile duct lithiasis: a prospective, comparative study. Am J Roentgenol. 2005;184:55–62.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Section of Emergency Ultrasound, York Hospital Emergency Ultrasound Fellowship, York Hospital Emergency Medicine Residency, York Hospital Department of Emergency Medicine, York, PA, USA

    Thompson Kehrl

  2. Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, CA, USA

    Mark Collin & Timothy Jang

Authors
  1. Thompson Kehrl
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  2. Mark Collin
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  3. Timothy Jang
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Corresponding author

Correspondence to Thompson Kehrl .

Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    Autumn Graham

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    David J. Carlberg

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Kehrl, T., Collin, M., Jang, T. (2019). How Should I Image the Patient with Suspected Liver or Biliary Disease?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_70

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  • DOI: https://doi.org/10.1007/978-3-319-98343-1_70

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98342-4

  • Online ISBN: 978-3-319-98343-1

  • eBook Packages: MedicineMedicine (R0)

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