Any of the above suggest cholecystitis PoCUS Findings of Acute Cholecystitis Impacted stone sludge pericholecystic fluid GBW thickened hyperemia PoCUS Findings of Acute Cholecystitis ID: 1043201
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1. When suspected clinically - Any of the above suggest cholecystitis**PoCUS Findings of Acute Cholecystitis
2. Impacted stone, sludge, pericholecystic fluid, GBW thickened, hyperemiaPoCUS Findings of Acute Cholecystitis
3. Beware of GBW Thickness
4. Mobile GS, thickened GB wall due to CHF
5. HIDACan we rely on Ultrasound alone (DI or PoCUS) to diagnose Acute Cholecystitis?
6. ..lithiasis or ..cystitisCan we improve sensitivity by adding other variables?Rule outRule in
7. What is required to Rule In Acute Cholecystitis?
8. Why is it important to diagnose AC early?
9. 1 + 2 + 3 negativeYesNoDI US ACAC can’t be ruled outAC unlikelyReassess +/- CAC very unlikelyD/C + F/UAC Ruled In: C2. Inflammatory Markers1. Murphy’s or RUQ Pain3. PoCUS AC1 + 2 positiveYesDI US ACAlternative Diagnosis Confirmede.g. RLL Pneumonia, SBO, Renal Colic, Pancreatitis, MI, etcXR, PoCUS, CT, ECG, LabsYesAC Ruled OutNoAC likely: C+ve-ve+ve-veAC unlikely not ruled outReassess +/- C1 + 2 + 3 positiveCognitive offloadDiagnostic Pathway Acute Cholecystitis (AC)C - consult
10. BOTTOM LINEPresents with symptoms suspicious for ACMurphy’s +ve + Elevated inflammatory markers+No alternate proven diagnosisSurgical Consult: ?ACDI US AC+ve or -ve -ve PoCUS AC does not impact need to consult if no alternate proven diagnosis
11. What PoCUS can impact?Presents with symptoms NOT especially suspicious for ACChest pain, back pain, vomiting, flank pain When +ve for ACCognitive offloadUnexpected Rule InShorter stayWhen -ve for ACAlthough not ruled-out – invest more effort earlier in looking for alternate diagnosisBroaden differential
12. ED Assessment5,500 Pts108Don’t feel bad about consults2021 Data SJRH