|
|
| (42 intermediate revisions by 11 users not shown) |
| Line 1: |
Line 1: |
| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Cholecystitis |
| | {| class="infobox" style="float:right;" |
| ICD10 = {{ICD10|K|81||k|80}} |
| | |- |
| ICD9 = {{ICD9|575.0}}, {{ICD9|575.1}} |
| | | [[File:Siren.gif|30px|link=Cholecystitis resident survival guide]]|| <br> || <br> |
| ICDO = |
| | | [[Cholecystitis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| Image = Chronic cholecystitis 001.jpg|
| | |} |
| Caption = Chronic Cholecystitis and Cholelithiasis: Gross natural color opened gallbladder with obviously thickened wall and fill-ed with faceted black calculi. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small> |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = med |
| |
| eMedicineTopic = 346 |
| |
| DiseasesDB = 2520 |
| |
| }}
| |
| {{Cholecystitis}} | | {{Cholecystitis}} |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
|
| |
|
| {{CMG}} | | {{CMG}}; {{AE}}, {{MMF}}, {{ADI}} |
|
| |
|
| {{Editor Help}}
| | ==[[Chronic cholecystitis overview|Overview]]== |
|
| |
|
| ==[[Cholecystitis overview|Overview]]== | | ==[[Chronic cholecystitis historical perspective|Historical Perspective]]== |
| | ==[[Chronic cholecystitis classification|Classification]]== |
|
| |
|
| ==[[Cholecystitis historical perspective|Historical Perspective]]== | | ==[[Chronic cholecystitis pathophysiology|Pathophysiology]]== |
|
| |
|
| ==[[Cholecystitis pathophysiology|Pathophysiology]]== | | ==[[Chronic cholecystitis causes|Causes]]== |
| | ==[[Chronic cholecystitis differential diagnosis|Differentiating Cholecystitis from other Diseases]]== |
| | ==[[Chronic cholecystitis epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| ==[[Cholecystitis epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Chronic cholecystitis risk factors|Risk Factors]]== |
|
| |
|
| ==[[Cholecystitis risk factors|Risk Factors]]== | | ==[[Chronic cholecystitis screening|Screening]]== |
|
| |
|
| ==[[Cholecystitis screening|Screening]]== | | ==[[Chronic cholecystitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| | |
| ==[[Cholecystitis causes|Causes]]==
| |
| | |
| ==[[Cholecystitis differential diagnosis|Differentiating Cholecystitis]]==
| |
| | |
| ==[[Cholecystitis natural history|Complications & Prognosis]]==
| |
|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| [[Cholecystitis history and symptoms|History and Symptoms]] | [[Cholecystitis physical examination|Physical Examination]] | [[Cholecystitis staging|Staging]] | [[Cholecystitis laboratory tests|Laboratory tests]] | [[Cholecystitis electrocardiogram|Electrocardiogram]] | [[Cholecystitis x ray|X Rays]] | [[Cholecystitis CT|CT]] | [[Cholecystitis MRI|MRI]] [[Cholecystitis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cholecystitis other imaging findings|Other images]] | [[Cholecystitis other diagnostic studies|Alternative diagnostics]] | | [[Chronic cholecystitis history and symptoms|History and Symptoms]] | [[Chronic cholecystitis physical examination|Physical Examination]] | [[Chronic cholecystitis laboratory findings|Laboratory Findings]] | [[Chronic cholecystitis electrocardiogram|Electrocardiogram]] | [[Chronic cholecystitis x ray|X Ray]] | [[Chronic cholecystitis CT|CT]] | [[Chronic cholecystitis MRI|MRI]] | [[Chronic cholecystitis ultrasound|Ultrasound]] | [[Chronic cholecystitis other imaging findings|Other Imaging Findings]] | [[Chronic cholecystitis other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| ==Treatment== | | ==Treatment== |
| [[Cholecystitis medical therapy|Medical therapy]] | [[Cholecystitis surgery|Surgical options]] | [[Cholecystitis primary prevention|Primary prevention]] | [[Cholecystitis secondary prevention|Secondary prevention]] | [[Cholecystitis cost-effectiveness of therapy|Financial costs]] | [[Cholecystitis future or investigational therapies|Future therapies]] | | [[Chronic cholecystitis medical therapy|Medical Therapy]] | [[Chronic cholecystitis surgery|Surgery]] | [[Chronic cholecystitis primary prevention|Primary Prevention]] | [[Chronic cholecystitis secondary prevention|Secondary Prevention]] | [[Chronic cholecystitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Chronic cholecystitis future or investigational therapies|Future or Investigational Therapies]] |
| | |
| ==Diagnosis==
| |
| | |
| Cholecystitis is usually diagnosed by a history of the above symptoms, as well examination findings:
| |
| | |
| * [[fever]] (usually low grade in uncomplicated cases)
| |
| * [[tender right upper quadrant]] +/- [[Murphy's sign]]
| |
| | |
| Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes.
| |
| | |
| == Differential diagnosis by acuity==
| |
| | |
| ===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 amoebic liver colitis
| |
| ***[[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
| |
| * [[Sickle Cell Disease]]
| |
| ==== Calculous Cholecystitis (Cholelithiasis) ====
| |
| * Female gender
| |
| * Hormonal therapy in women
| |
| * Idiopathic
| |
| * Increasing age
| |
| * [[Obesity]]
| |
| * Pregnancy
| |
| * Race: Scandinavians > African-Americans
| |
| * Rapid weight loss
| |
| | |
| == Investigations ==
| |
| ===Blood===
| |
| 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.
| |
| | |
| ===Radiology===
| |
| [[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 [[gallstone|cholelithiasis]] and sonographic [[Murphy's sign]]. Minor criteria include gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation. <ref name="Shea">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.</ref> <ref name="Fink">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.</ref>
| |
| | |
| The reported sensitivity and specificity of [[computed axial tomography|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 [[calculus (medicine)|calculi]] outside the [[lumen]] of the gallbladder. CT cannot see noncalcified gallbladder calculi, and cannot assess for a Murphy's sign. <ref name="Shea">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.</ref> <ref name="Fink">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.</ref>
| |
| | |
| Hepatobiliary [[nuclear medicine|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 gall bladder to expel bile (gall bladder ejection fraction), and low gall bladder 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. <ref name="Shea">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.</ref> <ref name="Fink">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.</ref>
| |
| | |
| ==Therapy==
| |
| [[Image:Laprascopy-Roentgen.jpg|thumb|left|260px|X-Ray during laparoscopic cholecystectomy]]
| |
| For most patients, in most centres, the definitive treatment is surgical removal of the gallbladder. Supportive measures are instituted in the meantime and to prepare the patient for surgery. These measures include fluid resuscitation and [[antibiotic]]s. Antibiotic regimens usually consist of a broad spectrum [[cephalosporin]] such as [[ceftriaxone]] and an antibacterial with good cover against [[anaerobic organism|anaerobic bacteria]], such as [[metronidazole]].
| |
| | |
| Gallbladder removal, [[cholecystectomy]], can be accomplished via open surgery or a [[laparoscopic]] procedure. Laparoscopic procedures can have less [[morbidity]] and a shorter recovery stay. Open procedures are usually done if complications have developed or the patient has had prior surgery to the area, making laparoscopic surgery technically difficult. A laparoscopic procedure may also be 'converted' to an open procedure during the operation if the surgeon feels that further attempts at laparoscopic removal might harm the patient. Open procedure may also be done if the surgeon does not know how to perform a laparoscopic cholesystectomy.
| |
| | |
| In cases of severe inflammation, shock, or if the patient has higher risk for general anesthesia (required for [[cholecystectomy]]), the managing physician may elect to have an [[interventional radiology|interventional radiologist]] insert a [[percutaneous]] drainage catheter into the gallbladder ('percutaneous cholecystostomy tube') and treat the patient with antibiotics until the acute inflammation resolves. The patient may later warrant [[cholecystectomy]] if their condition improves.
| |
| | |
| ==Complications of cholecystitis==
| |
| *[[Perforation]] or [[rupture]]
| |
| *[[Ascending cholangitis]]
| |
|
| |
|
| ===Complications of cholecystectomy=== | | ==Case Studies== |
| *bile leak ("biloma")
| | [[Chronic cholecystitis case study one|Case #1]] |
| *bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic surgeries have essentially equal injuries, but the recent trend is towards fewer injuries with laparoscopy, probably because the open cases often result because the gallbladder is too difficult or risky to remove with laparoscopy)
| | == Related Chapters == |
| *[[abscess]]
| |
| *[[wound]] [[infection]]
| |
| *[[bleeding]] (liver surface and cystic artery most common sites)
| |
| *[[hernia]]
| |
| *organ injury (intestine and liver at highest risk, especially if [[gallbladder]] through inflammation has become adherent/scarred to other organs (e.g. [[transverse colon]])
| |
| *[[deep vein thrombosis]]/[[pulmonary embolism]] (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)
| |
|
| |
| ====Gall bladder perforation====<!-- This section is linked from [[Gallbladder rupture]] -->
| |
| Gall bladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. The early diagnosis and treatment of GBP are crucial to patient morbidity and mortality. <ref name="pmid17203529">{{cite journal |author=Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E |title=Diagnosis and treatment of gallbladder perforation |journal=World J. Gastroenterol. |volume=12 |issue=48 |pages=7832-6 |year=2006 |pmid=17203529 |doi=}}</ref>
| |
| | |
| Approaches to this complication will vary based on the condition of an individual patient, the evaluation of the treating surgeon or physician, and the facilities' capability. It can happen at the neck from pressure necrosis of an impacted [[calculus]], or at the fundus. It can result in a local [[abscess]], or perforation into the general peritoneal cavity; if the bile, is infected diffuse [[peritonitis]] supervenes readily and rapidly. Death can result. <ref name="pmid17203529">{{cite journal |author=Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E |title=Diagnosis and treatment of gallbladder perforation |journal=World J. Gastroenterol. |volume=12 |issue=48 |pages=7832-6 |year=2006 |pmid=17203529 |doi=}}</ref>
| |
| | |
| A retrospective study looked at 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis. Patients were treated with analgesics and antibiotics within the first 36 hours after admission (with a mean of 9 hours), and proceeded to surgery for a [[cholecystectomy]]. Two patients died and 6 patients had further complications. The morbidity and mortality rates were 37.5% and 12.5%, respectively in the present study. The authors of this study suggests that early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance.<ref name="pmid17203529">{{cite journal |author=Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E |title=Diagnosis and treatment of gallbladder perforation |journal=World J. Gastroenterol. |volume=12 |issue=48 |pages=7832-6 |year=2006 |pmid=17203529 |doi=}}</ref>
| |
| | |
| ==Histopathological Findings: Chronic Cholecystitis==
| |
| | |
| <youtube v=gxGvP3GV_1E/>
| |
| | |
| == See also == | |
| * [[Boas' sign]] | | * [[Boas' sign]] |
|
| |
| ==References==
| |
| {{Reflist|2}}
| |
|
| |
|
| {{Gastroenterology}} | | {{Gastroenterology}} |
|
| |
| [[bs:Holecistitis]]
| |
| [[de:Cholezystitis]]
| |
| [[es:Colecistitis]]
| |
| [[fr:Cholécystite]]
| |
| [[hr:Kolecistitis]]
| |
| [[it:Colecistite]]
| |
| [[ja:胆嚢炎]]
| |
| [[pt:Colecistite]]
| |
| [[ru:Острый холецистит]]
| |
| [[sv:Gallblåseinflammation]]
| |
| [[pl:Zapalenie pęcherzyka żółciowego]]
| |
|
| |
|
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Hepatology]] | | [[Category:Hepatology]] |
| [[Category:Inflammations]] | | [[Category:Surgery]] |
| [[Category:General surgery]]
| |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Signs and symptoms]] | | [[Category:Disease]] |
| | |
|
| |
|
| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
