Abstract

Introduction: Abdominal pain in the right hypochondrium (RHD) is a frequent cause for which people go to the emergency department, although acute cholecystitis is usually the main reason, there are multiple differential diagnoses, which is why it is necessary to establish a quick and accurate cause can be a clinical and imaging challenge. Ultrasound is usually the study of choice in hepatobiliary disorders, however, with DHD of other origins, where evaluation becomes a challenge for the radiologist. Objective: To evaluate the relationship between pathological ultrasonographic findings with DHD in patients admitted for acute abdomen. Material and methods: Descriptive cross-sectional study, in a hospital of the Mexican Social Security Institute, Puebla, Mexico, from July 2022 to June 2023, in patients aged 18 to 70 years, both sexes, admitted to the emergency room for acute abdomen. Sociodemographic and clinical variables were studied, where an ultrasonographic evaluation of all structures of the right hypochondrium was performed. Descriptive statistics and Kappa coefficient were used to evaluate the agreement between clinical diagnosis and ultrasound findings, with a significant p value <0.05, obtained using SPSS v27 and MedCalc® Statistical Software version 22.009 (MedCalc Software Ltd, Ostend, Belgium; https:/ /www.medcalc. org; 2023). Results: 118 patients were studied, 69 (58.5%) women and 49 (41.5%) men. The most common comorbidities in women were diabetes and hypertension 34(49.3%), 11(16.0%) respectively, while in men diabetes predominated 23(46.9%) followed by hypertension 7(14.3%). Cholecystitis emerged as the main ultrasonographic finding in both sexes, followed by a normal USG in 15(21.8%) of women and 8(16.3%) of men. Despite this, considerable agreement [ƙ=0.78200] Standard error 0.040, approximate significance <0.001, 95% CI 0.70302-0.86098 was found between the initial ultrasound diagnosis and the definitive clinical diagnosis. Conclusion: cholecystitis is a common primary diagnosis for pain in the right upper quadrant, considering gallbladder conditions as a primary etiology, however a high percentage of patients do not present pathological findings, underlining the complexity of the diagnosis in clinical practice and the need to consider other diagnostic modalities or less conventional etiologies as causes

Keywords

diagnostic congruence, ultrasonographic findings, right upper quadrant, acute abdomen