Acalculous cholecystitis

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

Anatomy & Pathophysiology

  • Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
  • These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
  • Bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.

Gallbladder disease types

Risk Factors

Clinical Features

  • Similar to calculous cholecystitis
  • Jaundice is common (20% of patients)

Differential Diagnosis

RUQ Pain

Evaluation

Work-Up

Diagnosis

  • CBC
    • Leukocytosis (70-85% of patients)
  • LFTs
    • Hyperbilirubinemia
    • Alk phos elevation (mild)
    • Transaminitis
  • RUQ Ultrasound
    • 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

Disposition

  • Admit

See Also

  • Gallbladder Disease (Main)

References

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