Chronic cholecystitis differential diagnosis
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. It is associated with sharp and constant epigastric pain in the absence of fever, and there is usually a negative Murphy's sign. Liver function tests are within normal limits since the obstruction does not necessarily cause blockage in the common hepatic duct, thereby allowing normal bile excretion from the liver. An ultrasound scan is used to visualise the gallbladder and associated ducts, and also to determine the size and precise position of the obstruction.
- Choledocholithiasis — This refers to blockage of the common bile duct where a gallstone has left the gallbladder or has formed in the common bile duct (primary cholelithiasis). As with other biliary tree obstructions it is usually associated with 'colicky' pain, and because there is direct obstruction of biliary output, obstructive jaundice. Liver function tests will therefore show increased serum bilirubin, with high conjugated bilirubin. Liver enzymes will also be raised, predominately GGT and ALP, which are associated with biliary epithelium. The diagnosis is made using endoscopic retrograde cholangiopancreatography (ERCP), or the nuclear alternative (MRCP). One of the more serious complications of choledocholithiasis is acute pancreatitis, which may result in significant permanent pancreatic damage and brittle diabetes.
- Cholangitis — An infection of entire biliary tract, and may also be known as 'ascending cholangitis', which refers to the presence of pathogens that typically inhabit more distal regions of the bowel[1]
Cholangitis is a medical emergency as it may be life threatening and patients can rapidly succumb to acute liver failure or bacterial sepsis. The classical sign of cholangitis is Charcot's triad, which is right upper quadrant pain, fever and jaundice. Liver function tests will likely show increases across all enzymes (AST, ALT, ALP, GGT) with raised bilirubin. As with choledocholithiasis, diagnosis is confirmed using cholangiopancreatography.
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.