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| {{CMG}}; {{AE}} {{VR}}
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| ==Definitions==
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| {|class="wikitable"
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| ! Terms!! Definitions
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| | Cholecystitis|| Cholecystitis is an inflammatory disease of the gallbladder.
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| | Acute cholecystitis|| Acute cholecystitis is an acute inflammatory disease of the gallbladder, most often attributable to gallstones.<ref name="Strasberg-2008">{{Cite journal | last1 = Strasberg | first1 = SM. | title = Clinical practice. Acute calculous cholecystitis. | journal = N Engl J Med | volume = 358 | issue = 26 | pages = 2804-11 | month = Jun | year = 2008 | doi = 10.1056/NEJMcp0800929 | PMID = 18579815 }}</ref><ref name="Reiss-1993">{{Cite journal | last1 = Reiss | first1 = R. | last2 = Deutsch | first2 = AA. | title = State of the art in the diagnosis and management of acute cholecystitis. | journal = Dig Dis | volume = 11 | issue = 1 | pages = 55-64 | month = | year = 1993 | doi = | PMID = 8443956 }}</ref>
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| | Acute calculous cholecystitis|| Acute calculous cholecystitis is an acute inflammatory disease of the gallbladder in the presence of cholelithiasis.<ref name="Strasberg-2008">{{Cite journal | last1 = Strasberg | first1 = SM. | title = Clinical practice. Acute calculous cholecystitis. | journal = N Engl J Med | volume = 358 | issue = 26 | pages = 2804-11 | month = Jun | year = 2008 | doi = 10.1056/NEJMcp0800929 | PMID = 18579815 }}</ref> The [[Cholecystitis overview#Diagnostic Criteria|Tokyo guidelines]] is used in the diagnosis of acute calculous cholecystitis.<ref name="Takada-2007">{{Cite journal | last1 = Takada | first1 = T. | last2 = Kawarada | first2 = Y. | last3 = Nimura | first3 = Y. | last4 = Yoshida | first4 = M. | last5 = Mayumi | first5 = T. | last6 = Sekimoto | first6 = M. | last7 = Miura | first7 = F. | last8 = Wada | first8 = K. | last9 = Hirota | first9 = M. | title = Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 1-10 | month = | year = 2007 | doi = 10.1007/s00534-006-1150-0 | PMID = 17252291 }}</ref><ref name="Hirota-2007">{{Cite journal | last1 = Hirota | first1 = M. | last2 = Takada | first2 = T. | last3 = Kawarada | first3 = Y. | last4 = Nimura | first4 = Y. | last5 = Miura | first5 = F. | last6 = Hirata | first6 = K. | last7 = Mayumi | first7 = T. | last8 = Yoshida | first8 = M. | last9 = Strasberg | first9 = S. | title = Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 78-82 | month = | year = 2007 | doi = 10.1007/s00534-006-1159-4 | PMID = 17252300}}</ref>
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| | Acute acalculous cholecystitis|| Acute acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder in the absence of cholelithiasis and has a multifactorial pathogenesis.<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref> Data from multiple studies is used for suspecting the diagnosis of acute acalculous cholecystitis.<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref>
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| | 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.<ref name="Zhou-2013">{{Cite journal | last1 = Zhou | first1 = D. | last2 = Guan | first2 = WB. | last3 = Wang | first3 = JD. | last4 = Zhang | first4 = Y. | last5 = Gong | first5 = W. | last6 = Quan | first6 = ZW. | title = A comparative study of clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa. | journal = PLoS One | volume = 8 | issue = 7 | pages = e70265 | month = | year = 2013 | doi = 10.1371/journal.pone.0070265 | PMID = 23936177 }}</ref>
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| ==Causes==
| | '''[[Acute cholecystitis resident survival guide|Click here for acute cholecystitis.]]''' |
| ===Life Threatening Causes===
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| Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
| | '''[[Chronic cholecystitis resident survival guide|Click here for chronic cholecystitis.]]''' |
| *[[Cholecystitis natural history, complications and prognosis#Gangrenous cholecystitis|Gangrenous cholecystitis]]
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| ===Common Causes===
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| *[[Acalculous cholecystitis]]
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| *[[Calculous cholecystitis]]<ref name="Kimura-2007">{{Cite journal | last1 = Kimura | first1 = Y. | last2 = Takada | first2 = T. | last3 = Kawarada | first3 = Y. | last4 = Nimura | first4 = Y. | last5 = Hirata | first5 = K. | last6 = Sekimoto | first6 = M. | last7 = Yoshida | first7 = M. | last8 = Mayumi | first8 = T. | last9 = Wada | first9 = K. | title = Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 15-26 | month = | year = 2007 | doi = 10.1007/s00534-006-1152-y | PMID = 17252293 }}</ref>
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| ==Management==
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| Shown below is a diagram depicting the management of cholecystitis according to the Society for Surgery of the Alimentary Tract (SSAT),<ref name="Duncan-2012">{{Cite journal | last1 = Duncan | first1 = CB. | last2 = Riall | first2 = TS. | title = Evidence-based current surgical practice: calculous gallbladder disease. | journal = J Gastrointest Surg | volume = 16 | issue = 11 | pages = 2011-25 | month = Nov | year = 2012 | doi = 10.1007/s11605-012-2024-1 | PMID = 22986769 }}</ref> the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES),<ref name="Overby-2010">{{Cite journal | last1 = Overby | first1 = DW. | last2 = Apelgren | first2 = KN. | last3 = Richardson | first3 = W. | last4 = Fanelli | first4 = R. | last5 = Overby | first5 = DW. | last6 = Apelgren | first6 = KN. | last7 = Beghoff | first7 = KR. | last8 = Curcillo | first8 = P. | last9 = Awad | first9 = Z. | title = SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. | journal = Surg Endosc | volume = 24 | issue = 10 | pages = 2368-86 | month = Oct | year = 2010 | doi = 10.1007/s00464-010-1268-7 | PMID = 20706739 }}</ref> Tokyo guidelines for management of cholecystitis,<ref name="Mayumi-2013">{{Cite journal | last1 = Mayumi | first1 = T. | last2 = Someya | first2 = K. | last3 = Ootubo | first3 = H. | last4 = Takama | first4 = T. | last5 = Kido | first5 = T. | last6 = Kamezaki | first6 = F. | last7 = Yoshida | first7 = M. | last8 = Takada | first8 = T. | title = Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis. | journal = J UOEH | volume = 35 | issue = 4 | pages = 249-57 | month = Dec | year = 2013 | doi = | PMID = 24334691 }}</ref> and review of data from multiple studies on acalculous cholecystitis.<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref>
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| {{familytree/start |summary=Cholecystitis}}
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| {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms'''<br>❑ Abdominal pain</div>}}
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| {{familytree | | | | | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | | | | | | | | }}
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| {{familytree | | | | | | | | | B01 | | B02 | | B03 |,| B04 | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">❑ Acute RUQ or epigastric pain<br>
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| ❑ Sharp, severe and steady pain<br>
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| ❑ Pain for >6 hours<br>
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| ❑ Pain radiating to right shoulder blade<br>
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| ❑ Pain after food intake<br>
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| ❑ Pain aggravated by movements<br>
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| ❑ Pain associated with nausea & vomiting<br>
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| ❑ Pain associated with diaphoresis<br>
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| ❑ Pain associated with fever<br>
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| ❑ Pain associated with anorexia<br>
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| ❑ Pain associated with mass in the RUQ<br>
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| ❑ Pain associated with Sx suggestive of [[Sepsis history and symptoms|sepsis]]<br>❑ Pain associated with Sx suggestive of Mirizzi syndrome<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ RUQ pain with fever & jaundice</div></div><br>❑ Pain associated with Sx suggestive of gallstone ileus<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ Transient abdominal pain with nausea & vomiting
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| :❑ Hematemesis</div></div></div>|B02=<div style="float: left; text-align: left; line-height: 150% ">❑ Acute vague abdominal pain<br>❑ RUQ mass<br>❑ Jaundice<br>❑ Fever</div>|B03=<div style="float: left; text-align: left; line-height: 150% ">❑ Recurrent biliary type abdominal pain<br>❑ Recurrent abdominal bloating<br>❑ Unstable stool with constipation/diarrhea<br>❑ Weight loss</div>|B04=<div style="float: left; text-align: left; line-height: 150% ">'''Imaging studies:'''<br>[[Cholecystitis ultrasound#Chronic Calculous and Acalculous Cholecystitis|TAUSG]]<BR>[[Cholecystitis CT#Chronic Calculous and Acalculous Cholecystitis|CT abdomen]]<br>[[Cholecystitis other diagnostic studies#Chronic Cholecystitis|HIDA scan]]<br>[[Cholecystitis other diagnostic studies#Chronic Cholecystitis|Cholecystokinin stimulated HIDA scan]]</div>}}
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| {{familytree | | | | | | | | | |!| | | |!| | | |!| |!| |!| | | | | | | | | | |}}
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| {{familytree | | | | | | | | | C01 |-| C02 | | C03 |'| C04 | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:'''<BR>❑ Febrile<BR>❑ Jaundice<BR>❑ Dehydrated<BR>❑ Tachycardia<BR>❑ RUQ mass<BR>❑ Abdominal guarding<BR>❑ [[Murphy's sign]]<BR>❑ Abdominal crepitations<BR>❑ Abdominal tenderness<BR>❑ Reduced bowel sounds<BR>❑ Increased bowel sounds<BR>❑ Abdominal distension<BR>❑ [[Sepsis physical examination|Signs of sepsis]]</div>|C02=Consider DDx of '''acute acalculous cholecystitis'''|C03=Consider DDx of '''chronic cholecystitis'''|C04=<div style="float: left; text-align: left; line-height: 150% ">'''Uncomplicated chronic cholecystitis:'''<br>
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| Elective cholecystectomy<br>
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| '''Complicated chronic cholecystitis:'''<br>
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| Appropriate management of complications like [[Cholecystitis|acute on chronic cholecystitis]] or [[Gallbladder cancer|GB CA]] or [[Gallstone ileus#Treatment|gallstone ileus]]</div>}}
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| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | D01 |,| D02 |-| D03 |-|-|-|-|-|-|.| | | | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% ">'''Order laboratory tests:'''<br>❑ CBC<br>❑ BMP<br>❑ CRP<br>❑ Total bilirubin<br>❑ Direct bilirubin<br>❑ Albumin<br>❑ AST<br>❑ ALT<br>❑ Alkaline phosphatase<br>❑ GGT<br>❑ Amylase<br>❑ Lipase</div>|D02=No GBS/GB edema|D03=[[Abdominal pain resident survival guide|Consider evaluation for alternate diagnosis of abdominal pain]]}}
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| {{familytree | | | | | | | | | |!| |!| | | | | | | | | | | | | |!| | | | | | |}}
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| {{familytree | | | | | | | | | F01 |+| F02 |-| F03 |-| F04 | | |!| | | | | | | | | | | |F01='''Order urgent transabdominal USG (TAUSG)'''|F02=GBS w/o GB edema/GB edema w/o GBS|F03=HIDA scan|F04=GB opacity visualized}}
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| {{familytree | | | | | | | | | | | |!| | | | | |!| | | |!| | | |!| | | | |}}
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| {{familytree | | | | | | | | | | | |`| G01 | | G02 | | G03 | | |!| | | | | | | | | | |G01=GBS w/ GB edema|G02=GB opacity not visualized|G03=CT abdomen}}
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| {{familytree | | | | | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}}
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| {{familytree | | | | | | | | | H01 |-|-|^|-|-|-|'| | | H02 | | |!| | | | | | | | |H01=<div style="float: left; text-align: left; line-height: 150% ">'''[[Cholecystitis overview#Diagnostic Criteria|Diagnostic criteria]]''':<ref name="Takada-2007">{{Cite journal | last1 = Takada | first1 = T. | last2 = Kawarada | first2 = Y. | last3 = Nimura | first3 = Y. | last4 = Yoshida | first4 = M. | last5 = Mayumi | first5 = T. | last6 = Sekimoto | first6 = M. | last7 = Miura | first7 = F. | last8 = Wada | first8 = K. | last9 = Hirota | first9 = M. | title = Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 1-10 | month = | year = 2007 | doi = 10.1007/s00534-006-1150-0 | PMID = 17252291 }}</ref><ref name="Hirota-2007">{{Cite journal | last1 = Hirota | first1 = M. | last2 = Takada | first2 = T. | last3 = Kawarada | first3 = Y. | last4 = Nimura | first4 = Y. | last5 = Miura | first5 = F. | last6 = Hirata | first6 = K. | last7 = Mayumi | first7 = T. | last8 = Yoshida | first8 = M. | last9 = Strasberg | first9 = S. | title = Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 78-82 | month = | year = 2007 | doi = 10.1007/s00534-006-1159-4 | PMID = 17252300 }}</ref><br>❑ Local symptoms & signs<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ [[Murphy’s sign]]
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| :❑ Pain or tenderness in RUQ
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| :❑ Mass in RUQ</div></div><br>❑ Systemic signs<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ Fever
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| :❑ Leukocytosis
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| :❑ Elevated CRP</div></div><br>❑ Imaging findings<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ [[Cholecystitis ultrasound#Calculous Cholecystitis|TAUSG]]
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| :❑ [[Cholecystitis other diagnostic studies#Calculous Cholecystitis|HIDA scan]] </div></div></div>|H02=<div style="float: left; text-align: left; line-height: 150% ">'''Diagnostic criteria:'''<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref><BR>❑ Acute abdominal pain<BR>❑ Fever<BR>❑ Leukocytosis<BR>❑ Abnormal liver function tets<BR>❑ Imaging based criteria<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ [[Cholecystitis ultrasound#Imaging Criteria for Acalculous Cholecystitis|TAUSG based]]
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| :❑ [[Cholecystitis other diagnostic studies#Imaging Criteria for Acalculous Cholecystitis|HIDA scan based]]
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| :❑ [[Cholecystitis CT#Imaging Criteria for Acalculous Cholecystitis|CT based criteria]]</div></div></div>}}
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| {{familytree | | | | | | | | | |)|-|-| I01 |-| I02 | | |!| | | |!| | | | | | | |I01=W/ significantly elevated total bilirubin, alkaline phosphatase, ALT, AST &/or GGT|I02=Consider evaluation for alternate diagnosis like [[choledocholithiasis]] & [[cholangitis]]}}
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| {{familytree | | | | | | | | | J01 | | | | | | | | | | J02 | | |!| | | | | | | |J01='''Acute calculous cholecystitis'''<br>w/ or w/o complications|J02=Suspect '''acute acalculous cholecystitis'''}}
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| {{familytree | | | | | | | | | |!| | | | | | | | | | | |!| | | |!| | | | | |}}
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| {{familytree | | | | | | | | | K01 | | | | | | | | | | K02 |-| K03 | | | | | | | | |K01=<div style="float: left; text-align: left; line-height: 150% "><BR>❑ Hospital admission<BR>❑ NPO<br>❑ IVF & correct electrolyte abnormalities<br>❑ Empiric IV antibiotics<ref name="Solomkin-2003">{{Cite journal | last1 = Solomkin | first1 = JS. | last2 = Mazuski | first2 = JE. | last3 = Baron | first3 = EJ. | last4 = Sawyer | first4 = RG. | last5 = Nathens | first5 = AB. | last6 = DiPiro | first6 = JT. | last7 = Buchman | first7 = T. | last8 = Dellinger | first8 = EP. | last9 = Jernigan | first9 = J. | title = Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. | journal = Clin Infect Dis | volume = 37 | issue = 8 | pages = 997-1005 | month = Oct | year = 2003 | doi = 10.1086/378702 | PMID = 14523762 }}</ref><div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ Ceftriaxone 1 g IV every 24 hours or 2 g IV every 12 hours for CNS infections + Metronidazole 500 mg IV every 8 hours
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| '''or'''
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| :❑ Ciprofloxacin 400 mg IV every 12 hours/Levofloxacin 500 or 750 mg IV once daily + Metronidazole 500 mg IV every 8 hours</div></div><br>❑ Acute pain management<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
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| :❑ Ketorolac 30-60 mg IM/IV single dose
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| '''or'''
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| :❑ Opioids until cholecystectomy if ketorolac is contraindicated/pain not improving</div></div><br>
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| ❑ [[Cholecystitis overview#Severity Grading|Assess severity]]<ref name="Hirota-2007">{{Cite journal | last1 = Hirota | first1 = M. | last2 = Takada | first2 = T. | last3 = Kawarada | first3 = Y. | last4 = Nimura | first4 = Y. | last5 = Miura | first5 = F. | last6 = Hirata | first6 = K. | last7 = Mayumi | first7 = T. | last8 = Yoshida | first8 = M. | last9 = Strasberg | first9 = S. | title = Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 78-82 | month = | year = 2007 | doi = 10.1007/s00534-006-1159-4 | PMID = 17252300 }}</ref></div>|K02=Immediate biliary drainage|K03=Patient does not improve}}
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| {{familytree | | | | | | | | | |)|-|-|-|v|-|-|-|.| | | |!| | | | | | | | | }}
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| {{familytree | | | | | | | | | L01 | | L02 | | L03 | | L04 | | | | | | | | | | |L01=Grade 1 (Mild)|L02=Grade 2 (Moderate)|L03=Grade 3 (Severe)|L04=Patient improves}}
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| {{familytree | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | | |}}
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| {{familytree | | | | | | | | | M01 | | M02 | | M03 | | M04 | | | | |M01=Cholecystectomy within 72 hours|M02=<div style="float: left; text-align: left; line-height: 150% ">'''W/o complications & non high risk surgical candidates:'''<br>Immediate cholecystectomy + blood C&S ± bile C&S<br>'''W/o complications & high risk surgical candidates:'''<br>Immediate biliary drainage + blood C&S ± bile C&S<br>'''W/ complications:'''<br>Emergency cholecystectomy + blood C&S ± bile C&S ± appropriate surgeries for [[Gallstone ileus#Treatment|gallstone ileus]] & [[Mirizzi's syndrome surgery|Mirizzi syndrome]]</div>|M03=Emergency biliary drainage + blood C&S ± bile C&S|M04=Urgent cholecystectomy}}
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| {{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | N01 | | | | | | | | | | | |N01=Cholecystectomy after 3 months if GBS found during biliary drainage}}
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| {{familytree/end}}
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| <sup>†</sup>ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMP: Basic metabolic profile; C&S: Culture & sensitivity; CA: Carcinoma; CBC: Complete blood count; CT: Computed tomography; DDx: Differential diagnosis; GB: Gallbladder; GBS: Gallbladder stone; GGT: Gamma-glutamyl transpeptidase; HIDA scan: Hepatobiliary iminodiacetic acid scan; IV: Intravenous; IVF: Intravenous fluids; NPO: Nil per oral; RUQ: Right upper quadrant; Sx: Symptom; W/: With; W/O: Without
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|
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| ==Do's==
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| *Antibiotics should be administered if infection is suspected on the basis of laboratory and clinical findings (>12,500 white cells/mm <sup>3</sup> or temperature >38.5°C) and radiographic findings (e.g., air in the gallbladder or gallbladder wall) as per the Infectious Diseases Society of America recommendation.<ref name="Solomkin-2003">{{Cite journal | last1 = Solomkin | first1 = JS. | last2 = Mazuski | first2 = JE. | last3 = Baron | first3 = EJ. | last4 = Sawyer | first4 = RG. | last5 = Nathens | first5 = AB. | last6 = DiPiro | first6 = JT. | last7 = Buchman | first7 = T. | last8 = Dellinger | first8 = EP. | last9 = Jernigan | first9 = J. | title = Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. | journal = Clin Infect Dis | volume = 37 | issue = 8 | pages = 997-1005 | month = Oct | year = 2003 | doi = 10.1086/378702 | PMID = 14523762 }}</ref>
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| *Prophylactic antibiotics before surgery
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| **Should be administered in highrisk patients (age >60 years, presence of [[diabetes]], acute colic within 30 days of operation, [[jaundice]], [[acute cholecystitis]], or [[cholangitis]]) ([[SAGES system classification scheme|Level I, Grade B]]).
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| **Should be limited to a single preoperative dose given within 1 hour of skin incision ([[SAGES system classification scheme|Level II, Grade A]]).
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| *Early [[laparoscopic cholecystectomy]] is the preferred approach and should be done in patients with acute cholecystitis ([[SAGES system classification scheme|Level II, Grade B]]).
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| *Radiographically guided percutaneous cholecystostomy is the effective method of biliary drainage and should be done in critically ill patients with acute cholecystitis, until the patient recovers sufficiently to undergo cholecystectomy ([[SAGES system classification scheme|Level II, Grade B]]).
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| *Time to discharge after surgery for patients with acute cholecystitis should be determined on an individual basis ([[SAGES system classification scheme|Level III, Grade A]]).
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|
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| ==Dont's==
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| *Antibiotics are not required in low-risk patients undergoing laparoscopic cholecystectomy ([[SAGES system classification scheme|Level I, Grade A]]).
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| *Drains are not required after elective laparoscopic cholecystectomy, and their use may increase complication rates. ([[SAGES system classification scheme|Level I, Grade A]]).
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| ==References==
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| {{Reflist|2}}
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