From the Guidelines
The initial workup for a patient with cholelithiasis should start with abdominal ultrasonography due to its high sensitivity and specificity for detecting gallstones, as well as its low cost and lack of radiation exposure, as recommended by the most recent and highest quality study 1. The workup for cholelithiasis involves a comprehensive approach to confirm the presence of gallstones, assess for complications, and determine the relationship between symptoms and gallstones. Key components include:
- A comprehensive history and physical examination to identify symptoms and potential complications
- Laboratory tests such as complete blood count, liver function tests (ALT, AST, alkaline phosphatase, bilirubin), and pancreatic enzymes (amylase, lipase) to assess for complications
- Imaging studies, with abdominal ultrasonography as the first-line modality due to its high sensitivity (96% for detection of gallstones) and specificity, low cost, and lack of radiation exposure 1
- If complications are suspected or ultrasound results are inconclusive, additional imaging such as CT scan, MRCP (magnetic resonance cholangiopancreatography), or ERCP (endoscopic retrograde cholangiopancreatography) may be warranted, with the choice depending on the clinical context and local expertise 1
- HIDA scan (hepatobiliary iminodiacetic acid scan) can be useful to evaluate gallbladder function and diagnose biliary dyskinesia The goal of the workup is to guide appropriate management decisions, which may range from observation for asymptomatic patients to surgical intervention for those with symptomatic disease or complications, always prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
From the FDA Drug Label
Ultrasound images of the gallbladder should be obtained at 6-month intervals for the first year of Ursodiol therapy to monitor gallstone response The initial workup for a patient with cholelithiasis (gallstones) is not explicitly stated in the provided drug labels, but it can be inferred that ultrasound imaging of the gallbladder is a crucial step in monitoring gallstone response to treatment.
- Key points to consider:
From the Research
Initial Workup for Cholelithiasis
The initial workup for a patient with cholelithiasis (gallstones) typically involves a combination of physical examination, laboratory tests, and imaging studies.
- Physical examination may reveal right upper quadrant pain and a positive Murphy's sign, although the absence of these findings does not rule out the diagnosis 3.
- Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may be ordered to assist in diagnosing cholelithiasis 3.
- Ultrasonography is considered the gold standard for diagnosing cholelithiasis, as it is highly sensitive and specific for detecting gallstones 3, 4.
Imaging Studies
Imaging studies play a crucial role in the diagnosis of cholelithiasis.
- Endoscopic ultrasonography (EUS) is a highly sensitive method for diagnosing choledocholithiasis, with sensitivities of more than 95% reported in several studies 4.
- Magnetic resonance cholangiopancreatography (MRCP) may be used to evaluate the bile ducts and detect stones or other abnormalities 5.
- Transabdominal ultrasound (TUS) is often the initial imaging study used to evaluate the gallbladder and bile ducts, but it may not detect all cases of cholelithiasis 6.
Additional Diagnostic Tests
Additional diagnostic tests may be ordered in certain cases, such as:
- Cholecystokinin cholescintigraphy, which may be used to evaluate gallbladder function 6.
- Stimulated biliary drainage (SBD), which may be used to diagnose microlithiasis or other conditions 6.
- Endoscopic retrograde cholangiopancreatography (ERCP), which may be used to diagnose and treat choledocholithiasis 7, 5.