Cholecystitis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Cholecystitis

Definitions

Terms	Definitions
Cholecystitis	Cholecystitis is an inflammatory disease of the gallbladder.
Acute cholecystitis	Acute cholecystitis is an acute inflammatory disease of the gallbladder, most often attributable to gallstones.
Acute calculous cholecystitis	Acute calculous cholecystitis is an acute inflammatory disease of the gallbladder in the presence of cholelithiasis.
Acute acalculous cholecystitis	Acute acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder in the absence of cholelithiasis and has a multifactorial pathogenesis.
Chronic cholecystitis	Chronic cholecystitis is a chronic inflammatory disease of the gallbladder with histological evidence of chronic inflammation like large range of related inflammatory epithelial changes including mononuclear infiltrate, fibrosis, thickening of muscular layer, dysplasia, hyperplasia and metaplasia.

Acute Calculous Cholecystitis Diagnostic Criteria

According to Tokyo guidelines, presence of one local symptom or sign with one systemic sign and confirmatory imaging finding diagnosis acute calculous cholecystitis.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

References

Template:WikiDoc Sources

Characterize the symptoms ❑ Abdominal pain

❑ Acute biliary type abdominal pain ❑ Right upper quadrant or epigastric pain ❑ Sharp, severe and steady pain ❑ Pain for >6 hours ❑ Pain radiating to right shoulder blade ❑ Pain after food intake ❑ Pain aggravated by movements ❑ Pain associated with nausea & vomiting ❑ Pain associated with diaphoresis ❑ Pain associated with fever ❑ Pain associated with anorexia ❑ Pain associated with mass in the RUQ ❑ Sx suggestive of sepsis ❑ Sx suggestive of Mirizzi syndrome ❑ RUQ pain with fever & jaundice ❑ Sx suggestive of gallstone ileus ❑ Transient abdominal pain with nausea & vomiting ❑ Hematemesis

❑ Acute vague abdominal pain ❑ RUQ mass ❑ Jaundice

❑ Recurrent biliary type abdominal pain ❑ Recurrent abdominal bloating ❑ Unstable stool with constipation/diarrhea

Examine the patient: ❑ Febrile ❑ Tachycardia ❑ Dehydrated ❑ Abdominal guarding ❑ Murphy's sign ❑ Abdominal creps ❑ Abdominal tenderness ❑ Reduced bowel sounds ❑ Increased bowel sounds ❑ Abdominal distension ❑ Signs of sepsis

Consider Dx of acute acalculous cholecystitis

Consider Dx of chronic cholecystitis

Order laboratory tests: ❑ CBC ❑ BMP ❑ Total bilirubin ❑ Direct bilirubin ❑ Albumin ❑ AST ❑ ALT ❑ Alkaline phosphatase ❑ GGT ❑ Amylase ❑ Lipase

No GBS/GB edema

Consider evaluation for alternate diagnosis of abdominal pain

Order urgent transabdominal USG (TAUSG)

GBS w/o GB edema/GB edema w/o GBS}

HIDA scan

GB visualized

GBS w/ GB edema

GB not visualized

Diagnostic criteria: ❑ Local symptoms & signs ❑ Murphy’s sign ❑ Pain or tenderness in RUQ ❑ Mass in RUQ ❑ Systemic signs ❑ Fever ❑ Leukocytosis ❑ Elevated CRP ❑ Imaging findings ❑ TAUSG confirmatory finding of GBS & GB edema ❑ HIDA scan confirmatory finding of GBS & GB edema

Acute calculous cholecystitis