Chronic cholecystitis differential diagnosis: Difference between revisions
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* Rapid weight loss | * Rapid weight loss | ||
==Differentiating Cholecystitis from other Diseases== | |||
*Biliary colic | * [[Biliary colic ]] | ||
** Caused by obstruction of the [[cystic duct]] | ** Caused by obstruction of the [[cystic duct]] | ||
** Sharp and constant [[epigastric]] pain without [[fever]] | ** Sharp and constant [[epigastric]] pain without [[fever]] | ||
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** [[Liver function tests]] are normal | ** [[Liver function tests]] are normal | ||
*Choledocholithiasis | * [[Choledocholithiasis]] | ||
** Blockage of the [[common bile duct]] | ** Blockage of the [[common bile duct]] | ||
** Associated with 'colicky' pain | ** Associated with 'colicky' pain | ||
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** [[Liver function tests]] - increase in serum [[bilirubin]], high [[conjugated bilirubin]], raised [[gamma-glutamyl transpeptidase|GGT]] and [[alkaline phosphatase|ALP]] | ** [[Liver function tests]] - increase in serum [[bilirubin]], high [[conjugated bilirubin]], raised [[gamma-glutamyl transpeptidase|GGT]] and [[alkaline phosphatase|ALP]] | ||
*Cholangitis | * [[Cholangitis]] | ||
** An infection of entire biliary tract. | ** An infection of entire biliary tract. | ||
** It may involve pathogens of distal bowels and is also known as 'ascending cholangitis.<ref name="pmid1563308">{{cite journal |author=Sung JY; Costerton JW; Shaffer EA |title=Defense system in the biliary tract against bacterial infection |journal=World J. Gastroenterol. |volume=37 |issue=5 |pages=689–96 |year=1992 |pmid=1563308 |doi=10.1007/BF01296423}}</ref>. | ** It may involve pathogens of distal bowels and is also known as 'ascending cholangitis.<ref name="pmid1563308">{{cite journal |author=Sung JY; Costerton JW; Shaffer EA |title=Defense system in the biliary tract against bacterial infection |journal=World J. Gastroenterol. |volume=37 |issue=5 |pages=689–96 |year=1992 |pmid=1563308 |doi=10.1007/BF01296423}}</ref>. | ||
Revision as of 15:49, 20 August 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Differential diagnosis of Cholecystitis
Acute cholecystitis
- This should be suspected whenever there is acute right upper quadrant or epigastric pain.
Chronic cholecystitis
- The symptoms of chronic cholecystitis are non-specific, thus chronic cholecystitis may be mistaken for other common disorders:
- Peptic ulcer
- Hiatus hernia
- Colitis
- Functional bowel syndrome
Differential Diagnosis of Causes of Cholecystitis by Presence of a Stone
Acalculous Cholecystitis
- AIDS with cryptosporidiosis
- AIDS with Cytomegalovirus
- AIDS with microsporidiosis
- Burns
- Diabetes Mellitus
- Idiopathic
- Long-term total parenteral nutrition (TPN)
- Major surgery
- Myocardial infarction
- Other cardiac disease
- Prolonged fasting
- Salmonella
- Sepsis
- Seriously ill patients
- Severe trauma
- Sickle Cell Disease
Calculous Cholecystitis (Cholelithiasis)
- Female gender
- Hormonal therapy in women
- Idiopathic
- Increasing age
- Obesity
- Pregnancy
- Race: Scandinavians > African-Americans
- Rapid weight loss
Differentiating Cholecystitis from other Diseases
- Biliary colic
- Caused by obstruction of the cystic duct
- Sharp and constant epigastric pain without fever
- Murphy's sign is negative
- Liver function tests are normal
- Choledocholithiasis
- Blockage of the common bile duct
- Associated with 'colicky' pain
- Obstructive jaundice
- Liver function tests - increase in serum bilirubin, high conjugated bilirubin, raised GGT and ALP
- Cholangitis
- An infection of entire biliary tract.
- It may involve pathogens of distal bowels and is also known as 'ascending cholangitis.[1].
- The classical sign of cholangitis is Charcot's triad - which is right upper quadrant pain, fever and jaundice.
- Liver function tests - increase if enzymes (AST, ALT, ALP, GGT) with raised bilirubin.
- Bile is an extremely favorable growth medium for bacteria and infections develop rapidly and become quite severe.
References
- ↑ Sung JY; Costerton JW; Shaffer EA (1992). "Defense system in the biliary tract against bacterial infection". World J. Gastroenterol. 37 (5): 689–96. doi:10.1007/BF01296423. PMID 1563308.