The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021.


Obesity is a risk factor for development of gallstone disease. When acute cholecystitis is suspected, diagnostic workup typically includes ultrasonography, the gold standard and primary imaging study in gallbladder disease. However, acquiring high-quality ultrasound imaging in patients with obesity may be challenging, explained Erica A. Amianda, PA-C, and colleagues at the American Academy of PAs 2021 Conference (AAPA 2021).

“This study is significant for both ER and surgical PAs to understand that even subtle findings on ultrasound can indicate severe gallbladder disease,” Amianda said. “The surgeons at my institution felt that the ultrasound reports did not always correlate with the findings in the OR, which prompted us to look retrospectively at the cases here.” 

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To better understand the effects of BMI >30 on ultrasound accuracy in diagnosing the severity of acute cholecystitis, the researchers conducted a retrospective chart review of 392 patients admitted through the emergency department of an academic medical center who underwent cholecystectomy. Patients who underwent ultrasound 7 days or less prior to gallbladder surgery were included in the study. Severe gallbladder disease is defined as gangrenous or necrotic. Ultrasound findings were scored from 1 to 4 based on the number of positive findings and compared to the findings of the surgery pathology reports, Amianda said.

The following results were found using 2-way analysis of variance (ANOVA):

  • No significant interaction between BMI and severity of gallbladder disease (F1370 = 0.85, P =.356)
  • No significant difference in ultrasound results if BMI was greater than or less than 30 (P =.262)
  • Ultrasound results were significantly different than the severity of gallbladder disease found on pathology reports (P =.03)


No significant difference in ultrasound results that indicate acute cholecystitis was found in patients with obesity, and findings support continued use of ultrasonography alone to evaluate the severity of gallbladder disease in this population.

Limitations of the study included variability of ultrasonography technicians, interpretation of ultrasound results by radiologists, and small sample size.

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Amianda E, Gardner MS, Trutescu C, et al. Is ultrasound accurate in predicting the severity of acute gallbladder disease in patients with obesity. Poster presented at: American Academy of PAs Conference; May 23-26, 2021. Poster 182.