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Acute CholecystitisAka: Hydrops Gallbladder, Cholecystitis

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  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
        2. Clindamycin
        3. Gentamycin
    4. Laparoscopic Cholecystectomy
      1. Immediate Cholecystectomy is safe and preferred
      2. Stevens (2006) Am J Surg 192:756
    5. Alternatives to surgery
      1. Percutaneous cholecystostomy
      2. Extracorporeal Shock Wave Lithotripsy (ESWL)
      3. Oral Dissolution Therapy
  6. Course
    1. Spontaneous resolution in 60% of cases
  7. Complications
    1. Acute Pancreatitis
    2. Ascending Cholangitis
    3. Gallbladder Empyema
    4. Gallbladder Gangrene (Emphysematous Cholecystitis)

Cholecystitis (C0008325)

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.
ConceptsDisease or Syndrome (T047)
ICD9575.10
EnglishCholecystitis, GALL BLADDER INFLAMMATION, GALLBLADDER DISEASE 1, GALLBLADDER INFLAMM, Gallbladder Inflammation, GBD1, INFLAMMATION GALL BLADDER
Spanishcolecistitis
CreditsDerived from the NIH UMLS (Unified Medical Language System)


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.
ConceptsDisease or Syndrome (T047)
ICD9575.0
EnglishAcute cholecystitis, Acute cholecystitis unspecified, CHOLECYSTITIS ACUTE
Spanishcolecistitis aguda, colecistitis aguda no especificada
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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