Chronic cholecystitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Differential diagnosis by acuity

Acute cholecystitis

• This should be suspected whenever there is acute right upper quadrant or epigastric pain.
  • Other possible causes include:
    • Perforated peptic ulcer
    • Acute peptic ulcer exacerbation
    • Amoebic liver abscess
    • Acute pancreatitis
    • Acute intestinal obstruction
    • Renal colic
    • Acute retrocolic appendicitis

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