Chronic cholecystitis resident survival guide
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 with or without 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 symptoms ❑ Absence of other pain sources during CT ❑ Stone-free TAUSG ❑ Delayed gallbladder isotope accumulation, irregular gallbladder 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; GGT: Gamma-glutamyl transpeptidase; HIDA scan: Hepatobiliary iminodiacetic acid scan; TAUSG: Transabdominal ultrasonography
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)