Chronic cholecystitis differential diagnosis

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

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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..
  • 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.

Differential diagnosis of Cholecystitis

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

Calculous Cholecystitis (Cholelithiasis)

• Female gender
• Hormonal therapy in women
• Idiopathic
• Increasing age
• Obesity
• Pregnancy
• Race: Scandinavians > African-Americans
• Rapid weight loss
• Sickle Cell Disease