Acute cholecystitis

Acute cholecystitis 

Updated: 03/16/2021

© Jun Wang, MD, PhD

General features
  • With gallstone (acute calculous cholecystitis, >90% cases) or not (acute acalculous cholecystitis)
  • Associated with obstruction, biliary colic, ischemia and bacterial infection
  • May results in perforation
Clinical presentations
  • Acute inflammation: abdominal pain, right upper quadrant tenderness, nausea, vomiting, fever, leukocytosis, mild jaundice
  • Murphy sign
Pathological features
  • Enlarged, distended gallbladder
  • Acute inflammation, serosal and mucosal exudate, hemorrhage and necrosis
Laboratory features
  • Leukocytosis
  • Serum bilirubin and alkaline phosphatase may be NORMAL unless bile duct obstructed
Sonographic findings
Acute gangrenous cholecystitis
  • Mural infarction
  • High risk of perforation
  • Associated with Clostridium perfringes and air in gallbladder (pneumobilia)
  • High mortality rate
  • Transmural inflammation and infarct
Management
  • Cholecystectomy
  • Antibiotics



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