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Acalculous cholecystitis
From WikEM
Contents
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, 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
- Acute cholecystitis
- Cholangitis
- Symptomatic cholelithiasis
- Choledocholithiasis
- Acalculous cholecystitis
- Peptic ulcer disease with or without perforation
- Pancreatitis
- Acute hepatitis
- Pyelonephritis
- Pneumonia
- Kidney stone
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Herpes zoster
- Myocardial ischemia
- Bowel obstruction
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
Work-Up
- CBC
- Chemistry
- LFTs
- Blood cultures
- RUQ Ultrasound
Findings
- Leukocytosis (70-85% of patients)
- 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 with gas bubbles arising in fundus of gallbladder
- Frank perforation of gallbladder with associated abscess formation
Management
- Antibiotics
- Cholecystectomy
- Definitive therapy
Disposition
- Admit
See Also
References
Authors
Jordan Swartz, Ross Donaldson, Kevin Lu, Claire, Daniel Ostermayer, Neil Young