The Role of Ultrasound in Cholecystitis
The Role of Ultrasound in Cholecystitis
The aim of this study is:

 1. To describe the natural course of acute cholecystitis, by performing repeated ultrasound
 examinations from day of admission to hospital until day of surgery or discharge.

 2. To investigate if there is anything in the ultrasound picture that can predict a
 difficult operation.

 Patients will be prospectively enrolled. The ultrasound picture (ultrasound variables:
 gallbladder volume, gallbladder wall thickness, and presence of oedema in the gallbladder
 wall), will be compared to clinical variables (tenderness in right upper quadrant, WBC, CRP
 and temperature) and to the time (hours) from onset of symptoms. Statistical analyses will be
 made to see if statistically significant, and clinically relevant, associations between
 variables exist.

 Furthermore, for participants receiving acute surgery, an upper GI surgeon will evaluate the
 operation as easy, intermediate or difficult. In extension, investigators will look at
 associations between difficult surgery and all the variables previously mentioned (both
 ultrasound variables, clinical variables and time).
Patients admitted to Stockholm South General Hospital's Surgery Department, with a confirmed
 diagnosis of acute cholecystitis (according to the Tokyo Guidelines 2013) will be considered
 eligible for the study and asked to participate. Informed consent will be obtained from all
 participants. Participants will be examined with ultrasound of the gallbladder daily, while
 receiving regular care for acute cholecystitis, which means either waiting for acute surgery
 or being treated conservatively for as long as inpatient care is needed.

 The ultrasound examinations will be performed by a radiologist or a specialised certified
 ultrasound trained nurse as well as by an ultrasound trained surgeon. Measures of gallbladder
 volume (measured in cm3), gallbladder wall thickness (measured in mm:s) and presence of
 oedema in the gallbladder wall (noted as a binomial variable 'yes/no') are recorded in a case
 report form (no.1) together with body temperature, labs and information about onset of
 symptoms.

 The operating surgeon (a specialist in surgery) will evaluate the operation and grade it from
 easy to difficult and fill in a case report form (no.2).

 Data will be collected from the forms and analysed using a regression model (generalised
 estimated equation or a mixed model).
Inclusion Criteria:

 -  Acute cholecystitis according to the Tokyo Guidelines 2013 criteria

 Exclusion Criteria:

 -  Difficulties to communicate