Chronic cholecystitis resident survival guide: Difference between revisions
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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> | 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> | ||
==Management== | |||
Shown below are algorithms depicting the diagnostic and treatment approach of chronic 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> the 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> | |||
===Diagnostic Approach=== | |||
{{familytree/start |summary=Cholecystitis}} | |||
{{familytree | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:'''<br>❑ Recurrent biliary type abdominal pain w/ or w/o fever<br>❑ Recurrent abdominal bloating<br>❑ Unstable stool with [[constipation]]/[[diarrhea]]<br>❑ Weight loss</div>}} | |||
{{familytree | | | | | | | | |!| | | | | | | | |}} | |||
{{familytree | | | | | | | | B01 | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:'''<BR>❑ [[Febrile]]<BR>❑ [[Jaundice]]<BR>❑ [[Murphy's sign]]<BR>❑ Nonspecific finding</div>}} | |||
{{familytree | | | | | | | | |!| | | | | | | | |}} | |||
{{familytree | | | | | | | | C01 | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Probable diagnosis:'''<br>❑ Chronic cholecystitis | |||
---- | |||
'''Consider alternative diagnosis:'''<BR>❑ [[Biliary colic]]<BR>❑ [[Cholangiocarcinoma]]<BR>❑ [[Choledocholithiasis]]<BR>❑ [[Cholelithiasis]]<BR>❑ [[Gallbladder cancer]]<BR>❑ Gallbladder mucocele<BR>❑ [[Peptic ulcer disease]]</div>}} | |||
{{familytree | | | | | | | | |!| | | | | | | | |}} | |||
{{familytree | | | | | | | | D01 | | | | | | | |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 | |||
---- | |||
'''Order 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>}} | |||
{{familytree | | | | | | | | |!| | | | | | | | |}} | |||
{{familytree | | | | | | | | E01 | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150% ">'''Diagnostic criteria:'''<BR>❑ Chronic biliary Sx<BR>❑ Absence of other pain sources during CT<BR>❑ Stone-free TAUSG<br>❑ Delayed GB isotope accumulation, irregular GB filling, or photopenic areas and septations during HIDA cholescintigraphy<BR>❑ Low EF (<35%) in cholecystokinin stimulated HIDA scan</div>}} | |||
{{familytree | | | | | | | | |!| | | | | | | | |}} | |||
{{familytree | | | | | | | | F01 | | | | | | | |F01='''Suspect chronic cholecystitis'''}} | |||
{{familytree/end}} | |||
'''ALT:''' Alanine aminotransferase; '''AST:''' Aspartate aminotransferase; '''BMP:''' Basic metabolic profile; '''CBC:''' Complete blood count; '''CRP:''' C-reactive protein; '''CT:''' Computed tomography; '''EF:''' Ejection fraction; '''GB:''' Gallbladder; '''GGT:''' Gamma-glutamyl transpeptidase; '''HIDA scan:''' Hepatobiliary iminodiacetic acid scan; '''Sx:''' Symptom; '''TAUSG:''' Transabdominal ultrasonography; '''W/:''' With; '''W/O:''' Without | |||
===Treatment Approach=== | |||
{{familytree/start |summary=Cholecystitis}} | |||
{{familytree | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | |A01='''Chronic cholecystitis'''}} | |||
{{familytree | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | |}} | |||
{{familytree | | | | | | | | | | | | | B01 | | | | B02 | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Uncomplicated chronic cholecystitis:'''<br> | |||
❑ Elective cholecystectomy</div>|B02=<div style="float: left; text-align: left; line-height: 150% ">'''Complicated chronic cholecystitis:'''<br> | |||
Appropriate management of complications <BR>❑ [[Cholecystitis|Acute on chronic cholecystitis]]<BR>❑ [[Gallbladder cancer|Gallbladder carcinoma]]<BR>❑ [[Gallstone ileus#Treatment|Gallstone ileus]]</div>}} | |||
{{familytree/end}} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 16:43, 11 February 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]
Definitions
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.[1]
Management
Shown below are algorithms depicting the diagnostic and treatment approach of chronic cholecystitis according to the Society for Surgery of the Alimentary Tract (SSAT),[2] the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES),[3] the Tokyo guidelines for management of cholecystitis,[4] and review of data from multiple studies on acalculous cholecystitis.[5]
Diagnostic Approach
Characterize the symptoms: ❑ Recurrent biliary type abdominal pain w/ or w/o fever ❑ Recurrent abdominal bloating ❑ Unstable stool with constipation/diarrhea ❑ Weight loss | |||||||||||||||||||||||||||||||||||
Probable diagnosis: ❑ Chronic cholecystitis Consider alternative diagnosis: ❑ Biliary colic ❑ Cholangiocarcinoma ❑ Choledocholithiasis ❑ Cholelithiasis ❑ Gallbladder cancer ❑ Gallbladder mucocele ❑ Peptic ulcer disease | |||||||||||||||||||||||||||||||||||
Order laboratory tests: ❑ CBC ❑ BMP ❑ CRP ❑ Total bilirubin ❑ Direct bilirubin ❑ Albumin ❑ AST ❑ ALT ❑ Alkaline phosphatase ❑ GGT ❑ Amylase ❑ Lipase Order imaging studies: ❑ TAUSG ❑ CT abdomen ❑ HIDA scan ❑ Cholecystokinin stimulated HIDA scan | |||||||||||||||||||||||||||||||||||
Diagnostic criteria: ❑ Chronic biliary Sx ❑ Absence of other pain sources during CT ❑ Stone-free TAUSG ❑ Delayed GB isotope accumulation, irregular GB filling, or photopenic areas and septations during HIDA cholescintigraphy ❑ Low EF (<35%) in cholecystokinin stimulated HIDA scan | |||||||||||||||||||||||||||||||||||
| Suspect chronic cholecystitis | |||||||||||||||||||||||||||||||||||
ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMP: Basic metabolic profile; CBC: Complete blood count; CRP: C-reactive protein; CT: Computed tomography; EF: Ejection fraction; GB: Gallbladder; GGT: Gamma-glutamyl transpeptidase; HIDA scan: Hepatobiliary iminodiacetic acid scan; Sx: Symptom; TAUSG: Transabdominal ultrasonography; W/: With; W/O: Without
Treatment Approach
| Chronic cholecystitis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Uncomplicated chronic cholecystitis: ❑ Elective cholecystectomy | Complicated chronic cholecystitis: Appropriate management of complications ❑ Acute on chronic cholecystitis ❑ Gallbladder carcinoma ❑ Gallstone ileus | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Zhou, D.; Guan, WB.; Wang, JD.; Zhang, Y.; Gong, W.; Quan, ZW. (2013). "A comparative study of clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa". PLoS One. 8 (7): e70265. doi:10.1371/journal.pone.0070265. PMID 23936177.
- ↑ Duncan, CB.; Riall, TS. (2012). "Evidence-based current surgical practice: calculous gallbladder disease". J Gastrointest Surg. 16 (11): 2011–25. doi:10.1007/s11605-012-2024-1. PMID 22986769. Unknown parameter
|month=ignored (help) - ↑ Overby, DW.; Apelgren, KN.; Richardson, W.; Fanelli, R.; Overby, DW.; Apelgren, KN.; Beghoff, KR.; Curcillo, P.; Awad, Z. (2010). "SAGES guidelines for the clinical application of laparoscopic biliary tract surgery". Surg Endosc. 24 (10): 2368–86. doi:10.1007/s00464-010-1268-7. PMID 20706739. Unknown parameter
|month=ignored (help) - ↑ Mayumi, T.; Someya, K.; Ootubo, H.; Takama, T.; Kido, T.; Kamezaki, F.; Yoshida, M.; Takada, T. (2013). "Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis". J UOEH. 35 (4): 249–57. PMID 24334691. Unknown parameter
|month=ignored (help) - ↑ Huffman, JL.; Schenker, S. (2010). "Acute acalculous cholecystitis: a review". Clin Gastroenterol Hepatol. 8 (1): 15–22. doi:10.1016/j.cgh.2009.08.034. PMID 19747982. Unknown parameter
|month=ignored (help)