title: Detection of gall stones after acute pancreatitis.
abstract: Four methods of gall stone diagnosis after an attack of acute pancreatitis are analysed. Of 128 consecutive patients with acute pancreatitis, 99 patients were discharged from hospital without a definite aetiology. These patients had biochemical tests performed on admission and ultrasonography and oral cholecystography performed six weeks later. The sensitivity for ultrasonography was 87% and the specificity was 93%; the respective figures for oral cholecystography were 83% and 90%. The predictive value of positive ultrasonography was 100% and of negative ultrasonography 75%; the respective values for oral cholecystography were 95% and 68%. A combination of ultrasonography and oral cholecystography failed to detect nine of 70 patients with gall stones (13%). Of 35 patients with normal ultrasonography and oral cholecystography, 33 patients had an endoscopic retrograde cholangiogram (ERCP) which showed gall stones in a further seven patients. All three methods failed to reveal gall stones in two patients, confirmed by laparotomy. The sensitivity of admission biochemical analysis was 73% and the specificity was 94%; the predictive value of a positive result was 97% and of a negative result was 57%. Biochemical analysis predicted gall stones in six of the seven patients shown by ERCP. Only 9% of patients were finally considered to be idiopathic. In conclusion ultrasonography is the investigation of choice and ERCP should be undertaken in all patients who have normal ultrasonography and/or oral cholecystography but have biochemical criteria indicative of gall stones.
authors.forename: A J
authors.initials: AJ
authors.lastname: Goodman
authors.forename: J P
authors.initials: JP
authors.lastname: Neoptolemos
authors.forename: D L
authors.initials: DL
authors.lastname: Carr-Locke
authors.forename: D B
authors.initials: DB
authors.lastname: Finlay
authors.forename: D P
authors.initials: DP
authors.lastname: Fossard
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000681:Amylases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002765:Cholecystography; D002769:Cholelithiasis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D014463:Ultrasonography
chemical_list: D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D000681:Amylases; D001663:Bilirubin