From the Guidelines
For a patient with right upper quadrant pain suspected of having gallbladder (biliary) disease or bile duct obstruction, the most common laboratory tests include liver function tests (LFTs), complete blood count (CBC), and pancreatic enzymes, as these help assess liver damage, biliary obstruction, and potential pancreatitis, guiding diagnosis and treatment decisions 1.
Laboratory Tests for Biliary Disease
The following laboratory tests are essential in evaluating a patient with suspected biliary disease:
- Liver function tests (LFTs): alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and bilirubin (total and direct) to assess liver damage and biliary obstruction.
- Complete blood count (CBC) to reveal leukocytosis, suggesting inflammation or infection such as cholecystitis.
- Pancreatic enzymes like amylase and lipase to assess for potential pancreatitis caused by gallstone disease.
Imaging Studies
Imaging studies, particularly ultrasound, are crucial in diagnosing biliary disease, with a high accuracy for detecting gallstones and differentiating cholelithiasis from other gallbladder pathologies 1.
Additional Tests
Additional tests may include C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) to assess inflammation severity, and coagulation studies if surgical intervention is being considered.
Diagnosis and Treatment
These laboratory tests, combined with clinical presentation and imaging studies, help diagnose conditions such as cholelithiasis, cholecystitis, choledocholithiasis, or cholangitis, guiding appropriate treatment decisions 1.
From the Research
Laboratory Tests for Right Upper Quadrant Pain
The most common laboratory tests for a patient with right upper quadrant pain suspected of having gallbladder (biliary) disease or bile duct obstruction include:
- White blood cell count
- Liver enzymes
- Amylase
- Lipase 2
Imaging Tests
In addition to laboratory tests, imaging tests such as:
- Ultrasonography, which is the gold standard for diagnosis 2, 3
- Magnetic resonance cholangiopancreatography (MRCP) 4, 5
- Computed tomography (CT) 6, 5
- Radionuclide imaging 5
- MR imaging 5 may be used to evaluate patients with right upper quadrant pain and suspected gallbladder or bile duct disease.
Diagnostic Approach
A suggested approach for imaging patients with right upper quadrant pain and possible acute cholecystitis is presented in the literature, with ultrasonography being the initial imaging modality of choice 3. If ultrasonography is indeterminate, CT or MRCP may be used to further evaluate the patient 5.