Cholecystitis overview: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
Line 2: Line 2:
{|class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;
{|class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;
|-
|-
| {{#ev:youtube|https://https://www.youtube.com/watch?v=FdRhsEtz2qo|350}}
| {{#ev:youtube|https://https://www.youtube.com/watch?v=aU1lWPzUZgY|350}}
|-
|-
|}
|}

Latest revision as of 15:19, 11 July 2017

https://https://www.youtube.com/watch?v=aU1lWPzUZgY%7C350}}

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

Chronic cholecystitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cholecystitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cholecystitis overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cholecystitis overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cholecystitis overview

CDC on Cholecystitis overview

Cholecystitis overview in the news

Blogs on Cholecystitis overview

Directions to Hospitals Treating Cholecystitis

Risk calculators and risk factors for Cholecystitis overview

Overview

Cholecystitis is inflammation of the gallbladder.

Historical Perspective

Xanthogranulomatous cholecystitis (XGC) is a rare form of gall bladder disease which mimics gallbladder cancer although it is not cancerous. It was first discovered and reported in the medical literature in 1976 by J.J. McCoy, Jr., and colleagues.[1]. Eosinophilic cholecystitis was first described in 1949.[2].

Classification

Pathophysiology

Causes

Differentiating Cholecystitis overview from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

History and Symptoms

Cholecystitis usually presents as a pain in the right upper quadrant. This is usually a constant, severe pain. The pain may be felt to 'refer' to the right flank or right scapular region at first. This is usually accompanied by a low grade fever, vomiting and nausea. More severe symptoms such as high fever, shock and jaundice indicate the development of complications such as abscess formation, perforation or ascending cholangitis. Another complication, gallstone ileus, occurs if the gallbladder perforates and forms a fistula with the nearby small bowel, leading to symptoms of intestinal obstruction.

Chronic cholecystitis manifests with non-specific symptoms such as nausea, vague abdominal pain, belching, and diarrhea.

Physical Examination

Cholecystitis is usually diagnosed by a history of the symptoms, as well as examination findings like fever (usually low grade in uncomplicated cases) and a tender right upper quadrant +/- Murphy's sign. Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes.

Laboratory Findings

Laboratory values may be notable for an elevated alkaline phosphatase, possibly an elevated bilirubin (although this may indicate choledocholithiasis), and possibly an elevation of the WBC. CRP (C-reactive protein) is often elevated. The degree of elevation of these laboratory values may depend on the degree of inflammation of the gallbladder. Patients with acute cholecystitis are much more likely to manifest abnormal laboratory values, while in chronic cholecystitis the laboratory values are frequently normal.

Electrocardiogram

Acute cholecystitis presents as pain in the epigastrium, which can be confused with an acute myocardial infarction. ECG can be useful in excluding an MI.

CT

The reported sensitivity and specificity of CT scan findings are in the range of 90-95%. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and calculi outside the lumen of the gallbladder.

Ultrasound

Sonography is a sensitive and specific modality for diagnosis of acute cholecystitis; adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%, respectively. The 2 major diagnostic criteria are cholelithiasis and sonographic Murphy's sign. Minor criteria includes gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation. [3] [4]

Other Diagnostic Studies

Hepatobiliary scintigraphy with technetium-99m DISIDA (bilirubin) analog is also sensitive and accurate for diagnosis of chronic and acute cholecystitis. It can also assess the ability of the gallbladder to expel bile (gallbladder ejection fraction), and a low gallbladder ejection fraction has been linked to chronic cholecystitis. However, since most patients with right upper quadrant pain do not have cholecystitis, primary evaluation is usually accomplished with a modality that can diagnose other causes as well. [3] [4]

Diagnostic Criteria

The diagnostic criteria for acute cholecystitis according to Tokyo guidelines is as follows.[5][6]

Clinical Manifestations
Local symptoms and signs Murphy’s sign
Pain or tenderness in the right upper quadrant
Mass in the right upper quadrant
Systemic signs Fever
Leukocytosis
Elevated C-reactive protein level
Imaging findings A confirmatory finding on ultrasonography or hepatobiliary scintigraphy

Diagnosis: The presence of one local sign or symptom, one systemic sign, and a confirmatory finding on an imaging test.

Severity Grading

The severity grading for acute cholecystitis according to Tokyo guidelines is as follows.[6]

Grade Criteria
Mild (grade 1) Acute cholecystitis that does not meet the criteria for a more severe grade
Mild gallbladder inflammation without any organ dysfunction
Moderate (grade 2) The presence of one or more of the following:
Elevated white-cell count (>18,000 cells per cubic millimeter)
Palpable, tender mass in the right upper quadrant
Duration >72 hr
Marked local inflammation including biliary peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, emphysematous cholecystitis
Severe (grade 3) The presence of one or more of the following:
Cardiovascular dysfunction (hypotension requiring treatment with dopamine at ≥5 μg per kg of body weight per minute or any dose of dobutamine)
Neurologic dysfunction (decreased level of consciousness)
Respiratory dysfunction (ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300)
Renal dysfunction (oliguria; creatinine level, >2.0 mg/deciliter)
Hepatic dysfunction (prothrombin time–international normalized ratio, >1.5)
Hematologic dysfunction (platelet count, <100,000 per cubic millimeter)

Treatment

Medical Therapy

Surgery

Prevention

References

  1. Makino I, Yamaguchi T, Sato N, Yasui T, Kita I (2009). "Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET". World Journal of Gastroenterology : WJG. 15 (29): 3691–3. PMC 2721248. PMID 19653352. Retrieved 2012-08-20. Unknown parameter |month= ignored (help)
  2. Dabbs DJ (1993). "Eosinophilic and lymphoeosinophilic cholecystitis". The American Journal of Surgical Pathology. 17 (5): 497–501. PMID 8470764. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. 3.0 3.1 Shea, JA, Berlin, JA, Escarce, JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154:2573.
  4. 4.0 4.1 Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. The sensitivity of hepatobiliary imaging and real time ultrasonography in the detection of acute cholecystitis. Arch Surg 1985; 120:904.
  5. Takada, T.; Kawarada, Y.; Nimura, Y.; Yoshida, M.; Mayumi, T.; Sekimoto, M.; Miura, F.; Wada, K.; Hirota, M. (2007). "Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis". J Hepatobiliary Pancreat Surg. 14 (1): 1–10. doi:10.1007/s00534-006-1150-0. PMID 17252291.
  6. 6.0 6.1 Hirota, M.; Takada, T.; Kawarada, Y.; Nimura, Y.; Miura, F.; Hirata, K.; Mayumi, T.; Yoshida, M.; Strasberg, S. (2007). "Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 78–82. doi:10.1007/s00534-006-1159-4. PMID 17252300.

Template:WH Template:WS