Chronic cholecystitis resident survival guide: Difference between revisions

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==Management==
==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>
Shown below are algorithms depicting the diagnostic and therapeutic 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/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 | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''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 | | | | |!| | | | | | | | |}}
{{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 | | | | B01 | | | | | | | |B01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Examine the patient:'''<BR>❑ [[Febrile]]<BR>❑ [[Jaundice]]<BR>❑ [[Murphy's sign]]<BR>❑ Nonspecific finding</div>}}
{{familytree | | | | | | | | |!| | | | | | | | |}}
{{familytree | | | | |!| | | | | | | | |}}
{{familytree | | | | | | | | C01 | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Probable diagnosis:'''<br>❑ Chronic cholecystitis
{{familytree | | | | C01 | | | | | | | |C01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''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>}}
'''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 | | | | |!| | | | | | | | |}}
{{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
{{familytree | | | | D01 | | | | | | | |D01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''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>}}
'''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 | | | | |!| | | | | | | | |}}
{{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 | | | | E01 | | | | | | | |E01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''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 | | | | |!| | | | | |}}
{{familytree | | | | | | | | F01 | | | | | | | |F01='''Suspect chronic cholecystitis'''}}
{{familytree | | | | F01 | | | | |F01='''Confirm chronic cholecystitis'''}}
{{familytree | |,|-|-|^|-|-|.| | |}}
{{familytree | B01 | | | | B02 | |B01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Uncomplicated chronic cholecystitis:'''<br>
❑ Elective cholecystectomy</div>|B02=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''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}}
{{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
'''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 20:22, 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 therapeutic 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]

 
 
 
Characterize the symptoms:
❑ Recurrent biliary type abdominal pain w/ or w/o fever
❑ Recurrent abdominal bloating
❑ Unstable stool with constipation/diarrhea
❑ Weight loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
Febrile
Jaundice
Murphy's sign
❑ Nonspecific finding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Confirm chronic cholecystitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Uncomplicated chronic cholecystitis:
❑ Elective cholecystectomy
 
 
 
Complicated chronic cholecystitis:
Appropriate management of complications
Acute on chronic cholecystitis
Gallbladder carcinoma
Gallstone ileus
 

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

References

  1. 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.
  2. 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)
  3. 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)
  4. 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)
  5. 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)


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