title: Use of morphine cholescintigraphy in the diagnosis of acute cholecystitis in critically ill patients.
abstract: OBJECTIVE
  To determine the efficacy of morphine enhanced radionuclide cholescintigraphy (MC) in the diagnosis of acute cholecystitis (AC) in critically ill patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  2 university hospitals.
  
  
  METHODS
  Records of all ICU patients who underwent MC as part of an evaluation for AC over an 8 year period were reviewed (n = 45). All patients initially had standard radionuclide cholescintigraphy (RC) performed which showed nonvisualization of the gallbladder (GB) and were then given morphine sulfate (0.05-0.1 mg/kg i.v.).
  
  
  RESULTS
  The mean age was 54 years (range 18-84 years). Risk factors for AC included fasting in 41 patients (mean 12.4 days) and total parenteral nutrition in 32 patients. Signs of biliary sepsis included temperature > 100 degrees F in 38 patients, WBC > 10,000/ml3 in 40 patients, abdominal pain in 29 patients, and abnormal liver function tests in 42 patients. 23 patients had GB ultrasonography, with 7 showing stones. MC was positive (non-visualization) in 16 patients and negative (GB visualized) in 29, including 4 with gallstones. All patients in whom the GB was visualized did so within 1 h. There were 13 patients with positive MC who underwent operation; 12 had AC (9 acalculous, 3 calculous). Three patients were treated medically and recovered (false positive). All 29 patients with negative MC were true negatives. Overall, MC had an accuracy of 91%, sensitivity of 100%, specificity of 88%, positive predictive value of 75%, and negative predictive value of 100%.
  
  
  CONCLUSIONS
  MC is a useful test in the evaluation of critically ill patients for suspected AC, particularly in patients with known risk factors or documented gallstones.
authors.affiliation: Department of Surgery, Ohio State University Medical Center, Columbus 43210, USA.
authors.forename: L
authors.initials: L
authors.lastname: Flancbaum
authors.forename: P S
authors.initials: PS
authors.lastname: Choban
mesh_terms: D000208:Acute Disease; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D002764:Cholecystitis / Q000000981:diagnostic imaging*; D016638:Critical Illness; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019785:Technetium Tc 99m Disofenin
chemical_list: D007098:Imino Acids; D015609:Organotechnetium Compounds; D009020:Morphine; C003693:technetium Tc 99m PIPIDA; D019785:Technetium Tc 99m Disofenin