General Surgery  |  Gallbladder Pathway - Investigations

General Surgery

Gallbladder Pathway - Investigations

  • Abdominal Ultrasound

    • In patients presenting with suspected biliary disease, the abdominal ultrasound is used:

      • To diagnose biliary disease: Cholelithiasis: 98% sensitive and specific. Cholecystitis: 90-95% sensitive and 78-80% specific.
      • To exclude biliary disease.
      • To exclude alternative causes of the patient's symptoms.

    • For a patient to meet the criteria for Direct Access Gallbladder Surgery, the ultrasound should show a thin walled gallbladder with stones or sludge.
    • Note that false-positive gallbladder wall thickening may be seen in hypoalbuminaemia, ascites, congestive heart failure and carcinoma.

  • Liver function tests:

    • Normal in biliary colic.
    • In cholecystitis, Bilirubin, AST, ALT, and ALP levels may be elevated but not always.
    • Significantly elevated Bilirubin, AST, ALT, and ALP levels suggests common bile duct obstruction.
    • A high bilirubin suggests common bile duct obstruction.

  • Amylase

    • Normal in biliary colic.
    • May be elevated up to 3 times normal in cholecystitis.
    • Markedly elevated in pancreatitis caused by pancreatic duct obstruction.

  • Full blood countElectrolytes, urea, creatinine.

    • Normal in biliary colic.
    • A raised white blood cell count is frequently seen in cholecystitis.

  • Serum calcium if there is suspicion of biliary pancreatitis.

  • INR

    • If on warfarin.
    • May be raised in chronic liver disease (cirrhosis) and is useful if operative intervention is being considered in these patients.

Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

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