I. Symptoms and signs

  1. Biliary Colic with additional characteristics below
  2. Characteristics
    1. Starts as dull visceral poorly localized pain
    2. Develops into sharp parietal focal RUQ Pain
  3. Timing
    1. Pain persists beyond typical 6 hours
  4. Associated Symptoms
    1. Fever and chills frequently present

II. Signs

  1. Toxic appearance in moderate to severe discomfort
  2. Tachycardia
  3. RUQ Abdominal tenderness
  4. Peritoneal Signs
    1. Localized irritation comon
    2. Generalized signs (rare) suggests perforation
  5. Hypoactive bowel sounds
  6. Murphy Sign positive

III. Labs

  1. Complete Blood Count
    1. Leukocytosis with Left Shift
    2. Normal WBC Count does not rule out Cholecystitis
  2. Liver Function Tests (LFTs)
    1. Serum Bilirubin elevated
    2. Serum Alkaline Phosphatase elevated
    3. Serum Aminotransferases normal
  3. Pancreatic Studies
    1. Amylase
    2. Lipase
  4. Urine Studies
    1. Urinalysis
    2. Urine HCG

IV. Diagnostics

  1. XRay Abdomen
    1. Test Sensitivity for Gallstones: 10-20%
    2. Most stones are Cholesterol (radiolucent)
  2. Chest XRay
    1. Assess for Right Lower Lobe Pneumonia
    2. Assess for Pleural Effusion (seen in Pancreatitis)
  3. RUQ Ultrasound
    1. See Gallbladder Ultrasound for diagnostic criteria

V. Management

  1. Intravenous fluid hydration
  2. Nasogastric suction
  3. Antibiotics
    1. Initial antibiotic regimen
      1. Cefazolin IV
    2. Consider broadening antibiotics for severe cases
      1. Ampicillin with Gentamicin
      2. Ampicillin-Sulbactam
      3. Piperacillin-Tazobactam
  4. Laparoscopic Cholecystectomy
    1. Immediate Cholecystectomy is safe and preferred
    2. Stevens (2006) Am J Surg 192:756-61
  5. Alternatives to surgery
    1. Percutaneous cholecystostomy
    2. Extracorporeal Shock Wave Lithotripsy (ESWL)
    3. Oral Dissolution Therapy

VI. Course

  1. Spontaneous resolution in 60% of cases

VII. Complications

  1. Acute Pancreatitis
  2. Ascending Cholangitis
  3. Gallbladder Empyema
  4. Gallbladder Gangrene (Emphysematous Cholecystitis)

Images: Related links to external sites (from Google)

Ontology: Cholecystitis (C0008325)

Definition (NCI) An acute or chronic inflammation involving the gallbladder wall. It may be associated with the presence of gallstones.
Definition (NCI) A disorder characterized by inflammation involving the gallbladder. It may be associated with the presence of gallstones.
Definition (MSH) Inflammation of the GALLBLADDER; generally caused by impairment of BILE flow, GALLSTONES in the BILIARY TRACT, infections, or other diseases.
Definition (CSP) inflammation of the gallbladder; generally caused by impairment of bile flow, gallstones in the biliary tract, infections, or other diseases.
Concepts Disease or Syndrome (T047)
MSH D002764
ICD9 575.10
ICD10 K81 , K81.9
SnomedCT 197414008, 76581006
French CHOLECYSTITE, Cholécystite SAI, Cholécystite, Inflammation de la vésicule biliaire
English CHOLECYSTITIS, GALL BLADDER INFLAMMATION, INFLAMMATION GALL BLADDER, Cholecystitis, NOS, Cholecystitis, unspecified, Cholecystitis NOS, GALLBLADDER DISEASE 1, GBD1, GALLBLADDER INFLAMM, Cholecystitis, cholecystitis (diagnosis), cholecystitis, Cholecystitis NOS (disorder), Cholecystitis [Disease/Finding], gall bladder inflammation, gallbladder inflammation, Gallbladder inflammation, Inflammation gallbladder, Gallbladder Inflammation, Inflammation, Gallbladder, Cholecystitis (disorder), gallbladder; inflammation, inflammation; gallbladder
Portuguese COLECISTITE, Inflamação da vesícula biliar, Colecistite NE, Colecestite, Colecistite, Inflamação da Vesícula Biliar
Spanish COLECISTITIS, Colecistitis NEOM, Inflamación de la vesícula biliar, colecistitis (trastorno), colecistitis, SAI (trastorno), colecistitis, SAI, colecistitis, Colecistitis, Inflamación de la Vesícula Biliar, Inflamacion de la Vesicula Biliar
German CHOLEZYSTITIS, Gallenblasenentzuendung, Cholezystitis NNB, Entzuendung, Gallenblase, Cholezystitis, nicht naeher bezeichnet, Cholezystitis
Dutch cholecystitis NAO, galblaasontsteking, onsteking galblaas, galblaas; ontsteking, ontsteking; galblaas, Cholecystitis, niet gespecificeerd, cholecystitis, Cholecystitis, Galblaasontsteking
Italian Colecistite NAS, Infiammazione della colecisti, Infiammazione della vescica biliare, Colecistite
Japanese 胆嚢の炎症, 胆嚢炎NOS, タンノウエンNOS, タンノウエン, タンノウノエンショウ, 胆嚢炎, 胆嚢膿腫, 胆嚢蓄膿, 胆のう炎, 蓄膿-胆嚢
Swedish Gallblåseinflammation
Czech zánět žlučníku, cholecystitida, žlučník - zánět, Zánět žlučníku, Cholecystitida NOS, Cholecystitida
Finnish Sappirakkotulehdus
Russian KHOLETSISTIT, EMPIEMA ZHELCHNOGO PUZYRIA, ХОЛЕЦИСТИТ, ЭМПИЕМА ЖЕЛЧНОГО ПУЗЫРЯ
Korean 상세불명의 담낭염, 담낭염
Croatian KOLECISTITIS
Polish Zapalenie pęcherzyka żółciowego
Hungarian Cholecystitis, Cholecystitis k.m.n., Epehólyag-gyulladás, Epehólyag gyulladás

Ontology: Cholecystitis, Acute (C0149520)

Definition (MSH) Acute inflammation of the GALLBLADDER wall. It is characterized by the presence of ABDOMINAL PAIN; FEVER; and LEUKOCYTOSIS. Gallstone obstruction of the CYSTIC DUCT is present in approximately 90% of the cases.
Concepts Disease or Syndrome (T047)
MSH D041881
ICD9 575.0
ICD10 K81.0
SnomedCT 155827009, 197411000, 197409009, 65275009, 197408001
English CHOLECYSTITIS, ACUTE, Acute cholecystitis NOS, Acute cholecystitis unspecif., Acute cholecystitis unspecified, CHOLECYSTITIS ACUTE, acute cholecystitis (diagnosis), acute cholecystitis, Cholecystitis acute NOS, Acute cholecystitis NOS (disorder), Acute cholecystitis unspecified (disorder), Cholecystitis, Acute [Disease/Finding], Acute Cholecystitis, Cholecystitis, Acute, Cholecystitis acute, Acute cholecystitis, Acute cholecystitis (disorder), cholecystitis; acute, acute; cholecystitis
Dutch acute cholecystitis, cholecystitis acuut NAO, acuut; cholecystitis, cholecystitis; acuut, Acute cholecystitis, cholecystitis acuut, Cholecystitis, acute, Galblaasontsteking, acute
French Cholécystite aiguë SAI, Cholécystite aiguë, Cholécystite aigüe
German Cholezystitis akut NNB, akute Cholezystitis, Akute Cholezystitis, Cholezystitis, akute
Italian Colecistite acuta NAS, Colecistite acuta
Portuguese Colecistite aguda NE, Colecistite aguda, Colecestite aguda, Colecistite Aguda
Spanish Colecistitis aguda NEOM, Acute cholecystitis, colecistitis aguda (trastorno), colecistitis aguda no especificada (trastorno), colecistitis aguda no especificada, colecistitis aguda, SAI (trastorno), colecistitis aguda, SAI, colecistitis aguda, Colecistitis aguda, Colecistitis Aguda
Japanese 急性胆嚢炎NOS, キュウセイタンノウエンNOS, キュウセイタンノウエン, 急性胆嚢炎, 胆嚢炎-急性
Swedish Gallblåseinflammation, akut
Czech cholecystitida akutní, Akutní cholecystitida, Akutní cholecystitida NOS
Finnish Äkillinen sappirakkotulehdus
Russian KHOLETSISTIT OSTRYI, ХОЛЕЦИСТИТ ОСТРЫЙ
Korean 급성 담낭염
Polish Zapalenie pęcherzyka żółciowego ostre
Hungarian Acut cholecystitis, Heveny epehólyag-gyulladás, Acut cholecystitis k.m.n.