Acalculous cholecystitis

Revision as of 01:52, 21 October 2011 by Jswartz (talk | contribs) (Created page with "==Background== *Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis **Gallbladder stasis and ischemia leads to distension and eventually necrosis/perf...")
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

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

Risk Factors

  • Burns
  • CAD
  • DM
  • Immunosuppression
  • Infection
  • Mechanical ventilation
  • Medications (eg, opiates, sunitinib)
  • Multiple transfusions
  • Nonbiliary surgery
  • Sepsis/hypotension
  • Vasculitis

Clinical Features

  • Similar to calculous cholecystitis
  • Jaundice is common (20% of pts)

DDX

  1. Calculous cholecystitis
  2. Peptic ulceration w/ or w/o perforation
  3. Acute pancreatitis
  4. Right-sided pyelonephritis
  5. Hepatic or subphrenic abscess

Work-Up

  1. CBC
  2. Chemistry
  3. LFTs
  4. Blood cx
  5. Ultrasound

Diagnosis

  • Leukocytosis (70-85% of pts)
  • LFT abnormalities
    • Hyperbilirubinemia
    • Alk phos elevation (mild)
    • Transaminitis
  • Ultrasound findings:
    • Absence of gallstones or sludge
    • Thickened wall (>5 mm) with pericholecystic fluid
    • Positive sonographic Murphy's sign
    • Emphysematous cholecystitis w/ gas bubbles arising in fundus of gallbladder
    • Frank perforation of gallbladder with associated abscess formation

Treatment

  1. Abx
    1. Ceftriaxone + metronidazole OR
    2. Piperacillin/tazobactam
  2. Cholecystectomy
    1. Definitive therapy

Disposition

  • Admit

Source

  • UpToDate