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Southern Medical Journal:
doi: 10.1097/01.SMJ.0000129927.88863.65
Original Article

Association of Clinical and Laboratory Variables With Ultrasound Findings in Right Upper Quadrant Abdominal Pain

Mills, Lisa D. MD; Mills, Trevor MD; Foster, Barbara PHD

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Background: The purpose of this study was to determine how laboratory values and physical examination findings correlate with ultrasound findings in the setting of right upper quadrant pain.

Methods: Patients undergoing emergent ultrasound for the evaluation of biliary disease between November 1999 and April 2000 were included. Physical examination findings, laboratory data, and ultrasound results were variables. Logistic regression was performed. Ultrasound diagnosis of acute cholecystitis, cholelithiasis, and normal biliary tract were end points. One hundred seventy-seven patients were enrolled.

Results: Forty-two percent were diagnosed with acute cholecystitis, 30.5% with cholelithiasis, and 27.1% with normal biliary tract. Alkaline phosphatase, Murphy sign, white blood cell count, and total bilirubin were statistically significant predictors of acute cholecystitis. A Murphy sign was defined as arrest of inspiration with pressure over the right upper quadrant.

Conclusions: The findings from this study allow clinicians to apply objective significance to laboratory data and physical examination findings in patients with suspected gallstone disease. The data can be applied to create a predictive model.

Key Points

* Alkaline phosphatase, a Murphy sign, an elevated white blood cell count, and an elevated bilirubin are statistically significant predictors of acute cholecystitis.

* With an accurate predictive model, patient disposition can be determined without emergent imaging.

* This facilitates the clinician in determining early disposition of patient and early notification of consultants.

© 2005 Southern Medical Association


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