Acalculous cholecystitis: Difference between revisions
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{{Gallbladder background}} | {{Gallbladder background}} | ||
{{Gallbladder disease types}} | |||
===Risk Factors=== | ===Risk Factors=== | ||
*Burns | *[[Burns]] | ||
*CAD | *CAD | ||
*[[DM]] | *[[DM]] | ||
*Immunosuppression | *Immunosuppression | ||
*Infection | *[[Infection]] | ||
*Mechanical ventilation | *[[Mechanical ventilation]] | ||
*Medications (eg, opioids, sunitinib) | *Medications (eg, [[opioids]], sunitinib) | ||
*Multiple transfusions | *Multiple [[transfusions]] | ||
*Nonbiliary surgery | *Nonbiliary surgery | ||
*Sepsis/hypotension | *[[Sepsis]]/[[hypotension]] | ||
*Vasculitis | *[[Vasculitis]] | ||
*TPN, especially TPN > 3 mo | *TPN, especially TPN > 3 mo | ||
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===Work-Up=== | ===Work-Up=== | ||
*CBC | *CBC | ||
**Leukocytosis (70-85% of patients) | |||
*Chemistry | *Chemistry | ||
*LFTs | *[[LFTs]] | ||
**[[Hyperbilirubinemia]] | |||
**Hyperbilirubinemia | |||
**Alk phos elevation (mild) | **Alk phos elevation (mild) | ||
**Transaminitis | **Transaminitis | ||
*Ultrasound | *Blood cultures | ||
*[[RUQ Ultrasound]] | |||
**Absence of gallstones or sludge | **Absence of gallstones or sludge | ||
**Thickened wall (>5 mm) with pericholecystic fluid | **Thickened wall (>5 mm) with pericholecystic fluid | ||
**Positive sonographic Murphy's sign | **Positive sonographic Murphy's sign | ||
**Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder | **Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder | ||
**Frank perforation of gallbladder with associated abscess formation | **Frank perforation of gallbladder with associated [[abscess]] formation | ||
==Management== | ==Management== | ||
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==See Also== | ==See Also== | ||
[[Gallbladder Disease (Main)]] | *[[Gallbladder Disease (Main)]] | ||
==References== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] |
Revision as of 16:11, 25 October 2019
Background
- Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
- Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
- Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality
Anatomy & Pathophysiology
- Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
- These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
- Bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.
Gallbladder disease types
- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Acute calculous cholecystitis
- Ascending cholangitis
- Acalculous cholecystitis
- Biliary atresia
- Cholestasis of pregnancy
Risk Factors
- Burns
- CAD
- DM
- Immunosuppression
- Infection
- Mechanical ventilation
- Medications (eg, opioids, sunitinib)
- Multiple transfusions
- Nonbiliary surgery
- Sepsis/hypotension
- Vasculitis
- TPN, especially TPN > 3 mo
Clinical Features
- Similar to calculous cholecystitis
- Jaundice is common (20% of patients)
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
Work-Up
- CBC
- Leukocytosis (70-85% of patients)
- Chemistry
- LFTs
- Hyperbilirubinemia
- Alk phos elevation (mild)
- Transaminitis
- Blood cultures
- RUQ Ultrasound
- Absence of gallstones or sludge
- Thickened wall (>5 mm) with pericholecystic fluid
- Positive sonographic Murphy's sign
- Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder
- Frank perforation of gallbladder with associated abscess formation
Management
- Antibiotics
- Cholecystectomy
- Definitive therapy
Disposition
- Admit