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Cholecystitis
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Cholecystitis

ICD-10

K81

ICD-9

575.0, 575.1

DiseasesDB

2520

eMedicine

med/346

Cholecystitis is inflammation of the gallbladder. It is commonly due to impaction

(sticking) of a gallstone within the neck of the gall bladder, leading to inspissation of bile,
bile stasis, and infection by gut organisms. Cholecystitis may be a cause of right upper
quadrant pain. The pain may actually manifest in the right flank or scapular region at
first. In severe cases, the gall bladder can rupture and form an abscess. In severe cases, it
may lead to a life-threatening infection of the liver called ascending cholangitis. In other
cases, it may lead to a stable inflammatory state termed chronic cholecystitis.

Contents
[hide]

1 Diagnosis
2 Radiology
o 2.1 References
3 Therapy
4 Complications
o 4.1 of cholecystitis
o

4.2 of cholecystectomy

[edit]

Diagnosis
Acute cholecystitis classically presents with acute pain in the right upper quadrant of the
abdomen, nausea or vomiting, and fever. On physical examination, the pain may have
Murphy's sign, spasm of the diaphragm (due to the intense pain) when the region of the
gallbladder is palpated by the examiner.

Laboratory values may be notable for an elevated alkaline phosphatase, possibly an

elevated bilirubin (although this may indicate choledocholithiasis), and possibly an
elevation of the WBC count. The degree of elevation of these laboratory values may
depend on the degree of inflammation of the gallbladder. Patients with acute cholecystitis
are much more likely to manifest abnormal laboratory values, while in chronic
cholecystitis the laboratory values are frequently normal.
[edit]

Radiology
Sonography is a sensitive and specific modality for diagnosis of acute cholecystitis;
adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%,
respectively. The 2 major diagnostic criteria are cholelithiasis and sonographic Murphy's
sign. Minor criteria include gallbladder wall thickening greater than 3mm, pericholecystic
fluid, and gallbladder dilatation.
The reported sensitivity and specificity of CT scan findings are in the range of 90-95%.
CT is more sensitive than ultrasonography in the depiction of pericholecystic
inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas,
and calculi outside the lumen of the gallbladder. CT cannot see noncalcified gallbladder
calculi, and cannot assess for a Murphy's sign.
Hepatobiliary scintigraphy with technetium-99m DISIDA (bilirubin) analog is also
sensitive and accurate for diagnosis of chronic and acute cholecystitis. It can also assess
the ability of the gall bladder to expel bile (gall bladder ejection fraction), and low gall
bladder ejection fraction has been linked to chronic cholecystitis. However, since most
patients with right upper quadrant pain do not have cholecystitis, primary evaluation is
usually accomplished with a modality that can diagnose other causes, as well.
[edit]

References

Shea, JA, Berlin, JA, Escarce, JJ, et al. Revised estimates of diagnostic test
sensitivity and specificity in suspected biliary tract disease. Arch Intern Med
1994; 154:2573.
Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. The sensitivity of
hepatobiliary imaging and real time ultrasonography in the detection of acute
cholecystitis. Arch Surg 1985; 120:904.

[edit]

Therapy

X-Ray during laparascopic cholecystectomy

Although antibiotics will often help reduce the inflammation of the gallbladder, acute
cholecystitis is an indication for gallbladder removal (cholecystectomy). This can be
accomplished with an open surgery or a laparoscopic procedure. Laparoscopic procedures
can have less morbidity and a shorter recovery stay. An open procedure is preferred by
many surgeons if the gallbladder is so inflamed that it could fall apart with the
manipulations that could be needed with a laparoscopic procedure. A laparoscopic
procedure may also be 'converted' to an open procedure during the operation if the
surgeon feels that further attempts at laparoscopic removal might harm the patient.
In cases of severe inflammation, shock, or if the patient has higher risk for general
anesthesia (required for cholecystectomy), the managing physician may elect to have an
interventional radiologist insert a percutaneous drainage catheter into the gallbladder
('percutaneous cholecystostomy tube') and treat the patient with antibiotics until the acute
inflammation resolves. The patient may later warrant cholecystectomy if their condition
improves.
Gallbladder rupture is a possible but an unusual complication of cholecystitis.
Approaches to this complication will vary based on the condition of an individual patient,
the evaluation of the treating surgeon or physician, and the facilities' capability.
[edit]

Complications
[edit]

of cholecystitis

Rupture
Ascending cholangitis

[edit]

of cholecystectomy

bile leak ("biloma")

bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic
surgeries have essentially equal injuries, but the recent trend is towards fewer
injuries with laparoscopy, probably because the open cases often result because
the gallbladder is too difficult or risky to remove with laparoscopy)
abscess
wound infection
bleeding (liver surface and cystic artery most common sites)
hernia
organ injury (intestine and liver at highest risk, especially if gallbladder through
inflammation has become adherent/scarred to other organs[eg transverse colon])
deep vein thrombosis/pulmonary embolism (unusual- risk can be decreased
through use of sequential compression devices on legs during surgery)

Health science - Medicine - Gastroenterology - edit

Diseases of the esophagus - stomach
Halitosis | Nausea | Vomiting | GERD | Achalasia | Esophageal cancer |
Esophageal varices | Peptic ulcer | Abdominal pain | Stomach cancer |
Functional dyspepsia | Gastroparesis
Diseases of the liver - pancreas - gallbladder - biliary tree
Hepatitis | Cirrhosis | NASH | PBC | PSC | Budd-Chiari |
Hepatocellular carcinoma | Acute pancreatitis | Chronic pancreatitis |
Pancreatic cancer | Gallstones | Cholecystitis
Diseases of the small intestine
Peptic ulcer | Intussusception | Malabsorption (e.g. Coeliac,
lactose intolerance, fructose malabsorption, Whipple's) | Lymphoma
Diseases of the colon
Diarrhea | Appendicitis | Diverticulitis | Diverticulosis |
IBD (Crohn's, Ulcerative colitis) | IBS | Constipation | Colorectal cancer |
Hirschsprung's | Pseudomembranous colitis

Retrieved from "http://en.wikipedia.org/wiki/Cholecystitis"

Categories: Gastroenterology | Inflammations | General surgery
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This page was last

modified 16:08, 22
May 2006.
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