Although the etiology of both forms of acute cholecystitis are different, the indications and symptoms of acute calculous and acute acalculous are similar. Symptomatically, acute calculous cholecystitis can also present similarly to acute pancreatitis, perforated peptic ulcer, liver abscess, or hepatitis and can be differentiated successfully with ultrasound. Furthermore, upon physical examination an indication of acute cholecystitis is a positive Murphy's Sign which is a sudden increase in pain during palpation of the RUQ during inhalation. If the gallbladder is palpable than there is a strong indication of obstruction. Laboratory values can also be an indicative of acute cholecystitis when there is leukocytosis, hyperbilirubinemia, and an increase in alkaline phosphatase with a concurrent increase in AST and ALT Though, cumulatively these lab results are not as diagnostic as the Sonographic Murphy's Sign, when evaluated in addition to the sonographic study a diagnosis can be confirmed.
Sonography is an important tool in the diagnosis of acute cholecystitis.
The second set of sonographic criteria are dilatation of the gallbladder, sludge, widespread wall thickening, and generalized striated wall thickening. Striated wall thickening appears as irregular, transparent echogenic bands with in the gallbladder wall. In order to obtain these views, proper placement of the transducer is necessary. This placement should be over the central axis of the gallbladder. Improper angulation of the transducer can alter the size of the wall thickness, thus distorting the image.