Cholecystitis resident survival guide: Difference between revisions

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{{CMG}}; {{AE}} {{VR}}
{{CMG}}; {{AE}} {{VR}}


==Cholecystitis==
==Definitions==
===Definitions===
{|class="wikitable"
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! Terms!! Definitions
! Terms!! Definitions
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===Causes===
==Causes==
====Life Threatening Causes====
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Cholecystitis natural history, complications and prognosis#Gangrenous cholecystitis|Gangrenous cholecystitis]]
*[[Cholecystitis natural history, complications and prognosis#Gangrenous cholecystitis|Gangrenous cholecystitis]]


====Common Causes====
===Common Causes===
*[[Acalculous cholecystitis]]
*[[Acalculous cholecystitis]]
*[[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>
*[[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>


===Management===
==Management==
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>
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>
{{familytree/start |summary=Cholecystitis}}
{{familytree/start |summary=Cholecystitis}}
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{{familytree | | | | | | | | | | | | | | | | | N01 | | | | | | | | | | | |N01=Cholecystectomy after 3 months if GBS found during biliary drainage}}
{{familytree | | | | | | | | | | | | | | | | | N01 | | | | | | | | | | | |N01=Cholecystectomy after 3 months if GBS found during biliary drainage}}
{{familytree/end}}
{{familytree/end}}
<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     
<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     


==Do's==
==Do's==
*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>
*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>
*Prophylactic antibiotics before surgery  
*Prophylactic antibiotics before surgery  
**Should be administered in highrisk patients (age >60 years, presence of [[diabetes]], acute colic within 30 days of operation, [[jaundice]], [[acute cholecystitis]], or [[cholangitis]]). (Level I, Grade B)
**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]]).
**Should be limited to a single preoperative dose given within 1 hour of skin incision. (Level II, Grade A)
**Should be limited to a single preoperative dose given within 1 hour of skin incision ([[SAGES system classification scheme|Level II, Grade A]]).
*Early [[laparoscopic cholecystectomy]] is the preferred approach and should be done in patients with acute cholecystitis. (Level II, Grade B)
*Early [[laparoscopic cholecystectomy]] is the preferred approach and should be done in patients with acute cholecystitis ([[SAGES system classification scheme|Level II, Grade B]]).
*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. (Level II, Grade B)
*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]]).
*Time to discharge after surgery for patients with acute cholecystitis should be determined on an individual basis. (Level III, Grade A)
*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]]).


==Dont's==
==Dont's==
*Antibiotics are not required in low-risk patients undergoing laparoscopic cholecystectomy. (Level I, Grade A)
*Antibiotics are not required in low-risk patients undergoing laparoscopic cholecystectomy ([[SAGES system classification scheme|Level I, Grade A]]).
*Drains are not required after elective laparoscopic cholecystectomy, and their use may increase complication rates. (Level I, Grade A)
*Drains are not required after elective laparoscopic cholecystectomy, and their use may increase complication rates. ([[SAGES system classification scheme|Level I, Grade A]]).
 
==Levels of Evidence and Scales Used for Recommendation Grading==
The levels of evidence and scales used for recommendation grading is as follows.<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>
{|class="wikitable"
!Levels of evidence and scales for grading !! Definition
|-
| Level I|| Evidence from properly conducted randomized, controlled trials
|-
| Level II || Evidence from controlled trials without randomization<br>or<br>Cohort or case–control studies<br>or<br>Multiple time series, dramatic uncontrolled experiments
|-
| Level III || Descriptive case series, opinions of expert panels
|-
| Grade A|| Based on high-level (level I or II), well-performed studies with uniform interpretation and conclusions by the expert panel
|-
| Grade B|| Based on high-level, well-performed studies with varying interpretation and conclusions by the expert panel
|-
| Grade C|| Based on lower-level evidence (level II or less) with inconsistent findings and/or varying interpretations or conclusions by the expert panel
|}


==References==
==References==

Revision as of 16:44, 28 January 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

Terms Definitions
Cholecystitis Cholecystitis is an inflammatory disease of the gallbladder.
Acute cholecystitis Acute cholecystitis is an acute inflammatory disease of the gallbladder, most often attributable to gallstones.[1][2]
Acute calculous cholecystitis Acute calculous cholecystitis is an acute inflammatory disease of the gallbladder in the presence of cholelithiasis.[1] The Tokyo guidelines is used in the diagnosis of acute calculous cholecystitis.[3][4]
Acute acalculous cholecystitis Acute acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder in the absence of cholelithiasis and has a multifactorial pathogenesis.[5] Data from multiple studies is used for suspecting the diagnosis of acute acalculous cholecystitis.[5]
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.[6]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Shown below is a diagram depicting the management of cholecystitis according to the Society for Surgery of the Alimentary Tract (SSAT),[8] the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES),[9] Tokyo guidelines for management of cholecystitis,[10] and review of data from multiple studies on acalculous cholecystitis.[5]

 
 
 
 
 
 
 
 
 
 
 
 
Characterize the symptoms
❑ Abdominal pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Acute RUQ or epigastric pain

❑ Sharp, severe and steady pain
❑ Pain for >6 hours
❑ Pain radiating to right shoulder blade
❑ Pain after food intake
❑ Pain aggravated by movements
❑ Pain associated with nausea & vomiting
❑ Pain associated with diaphoresis
❑ Pain associated with fever
❑ Pain associated with anorexia
❑ Pain associated with mass in the RUQ

❑ Pain associated with Sx suggestive of sepsis
❑ Pain associated with Sx suggestive of Mirizzi syndrome
❑ RUQ pain with fever & jaundice

❑ Pain associated with Sx suggestive of gallstone ileus
❑ Transient abdominal pain with nausea & vomiting
❑ Hematemesis
 
❑ Acute vague abdominal pain
❑ RUQ mass
❑ Jaundice
❑ Fever
 
❑ Recurrent biliary type abdominal pain
❑ Recurrent abdominal bloating
❑ Unstable stool with constipation/diarrhea
❑ Weight loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
❑ Febrile
❑ Jaundice
❑ Dehydrated
❑ Tachycardia
❑ RUQ mass
❑ Abdominal guarding
Murphy's sign
❑ Abdominal crepitations
❑ Abdominal tenderness
❑ Reduced bowel sounds
❑ Increased bowel sounds
❑ Abdominal distension
Signs of sepsis
 
Consider DDx of acute acalculous cholecystitis
 
Consider DDx of chronic cholecystitis
 
 
Uncomplicated chronic cholecystitis:

Elective cholecystectomy
Complicated chronic cholecystitis:

Appropriate management of complications like acute on chronic cholecystitis or GB CA or gallstone ileus
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order laboratory tests:
❑ CBC
❑ BMP
❑ CRP
❑ Total bilirubin
❑ Direct bilirubin
❑ Albumin
❑ AST
❑ ALT
❑ Alkaline phosphatase
❑ GGT
❑ Amylase
❑ Lipase
 
 
No GBS/GB edema
 
Consider evaluation for alternate diagnosis of abdominal pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order urgent transabdominal USG (TAUSG)
 
 
GBS w/o GB edema/GB edema w/o GBS
 
HIDA scan
 
GB opacity visualized
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
GBS w/ GB edema
 
GB opacity not visualized
 
CT abdomen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnostic criteria:[3][4]
❑ Local symptoms & signs
Murphy’s sign
❑ Pain or tenderness in RUQ
❑ Mass in RUQ

❑ Systemic signs
❑ Fever
❑ Leukocytosis
❑ Elevated CRP

❑ Imaging findings
TAUSG
HIDA scan
 
 
 
 
 
 
 
 
 
 
 
Diagnostic criteria:[5]
❑ Acute abdominal pain
❑ Fever
❑ Leukocytosis
❑ Abnormal liver function tets
❑ Imaging based criteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
W/ significantly elevated total bilirubin, alkaline phosphatase, ALT, AST &/or GGT
 
Consider evaluation for alternate diagnosis like choledocholithiasis & cholangitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute calculous cholecystitis
w/ or w/o complications
 
 
 
 
 
 
 
 
 
Suspect acute acalculous cholecystitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

❑ Hospital admission
❑ NPO
❑ IVF & correct electrolyte abnormalities
❑ Empiric IV antibiotics[11]
❑ Ceftriaxone 1 g IV every 24 hours or 2 g IV every 12 hours for CNS infections + Metronidazole 500 mg IV every 8 hours

or

❑ Ciprofloxacin 400 mg IV every 12 hours/Levofloxacin 500 or 750 mg IV once daily + Metronidazole 500 mg IV every 8 hours

❑ Acute pain management
❑ Ketorolac 30-60 mg IM/IV single dose

or

❑ Opioids until cholecystectomy if ketorolac is contraindicated/pain not improving

Assess severity[4]
 
 
 
 
 
 
 
 
 
Immediate biliary drainage
 
Patient does not improve
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Grade 1 (Mild)
 
Grade 2 (Moderate)
 
Grade 3 (Severe)
 
Patient improves
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cholecystectomy within 72 hours
 
W/o complications & non high risk surgical candidates:
Immediate cholecystectomy + blood C&S ± bile C&S
W/o complications & high risk surgical candidates:
Immediate biliary drainage + blood C&S ± bile C&S
W/ complications:
Emergency cholecystectomy + blood C&S ± bile C&S ± appropriate surgeries for gallstone ileus & Mirizzi syndrome
 
Emergency biliary drainage + blood C&S ± bile C&S
 
Urgent cholecystectomy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cholecystectomy after 3 months if GBS found during biliary drainage
 
 
 
 
 
 
 
 
 
 
 

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

Do's

  • Antibiotics should be administered if infection is suspected on the basis of laboratory and clinical findings (>12,500 white cells/mm 3 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.[11]
  • Prophylactic antibiotics before surgery
  • Early laparoscopic cholecystectomy is the preferred approach and should be done in patients with acute cholecystitis (Level II, Grade B).
  • 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 (Level II, Grade B).
  • Time to discharge after surgery for patients with acute cholecystitis should be determined on an individual basis (Level III, Grade A).

Dont's

  • Antibiotics are not required in low-risk patients undergoing laparoscopic cholecystectomy (Level I, Grade A).
  • Drains are not required after elective laparoscopic cholecystectomy, and their use may increase complication rates. (Level I, Grade A).

References

  1. 1.0 1.1 Strasberg, SM. (2008). "Clinical practice. Acute calculous cholecystitis". N Engl J Med. 358 (26): 2804–11. doi:10.1056/NEJMcp0800929. PMID 18579815. Unknown parameter |month= ignored (help)
  2. Reiss, R.; Deutsch, AA. (1993). "State of the art in the diagnosis and management of acute cholecystitis". Dig Dis. 11 (1): 55–64. PMID 8443956.
  3. 3.0 3.1 Takada, T.; Kawarada, Y.; Nimura, Y.; Yoshida, M.; Mayumi, T.; Sekimoto, M.; Miura, F.; Wada, K.; Hirota, M. (2007). "Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis". J Hepatobiliary Pancreat Surg. 14 (1): 1–10. doi:10.1007/s00534-006-1150-0. PMID 17252291.
  4. 4.0 4.1 4.2 Hirota, M.; Takada, T.; Kawarada, Y.; Nimura, Y.; Miura, F.; Hirata, K.; Mayumi, T.; Yoshida, M.; Strasberg, S. (2007). "Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 78–82. doi:10.1007/s00534-006-1159-4. PMID 17252300.
  5. 5.0 5.1 5.2 5.3 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)
  6. 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.
  7. Kimura, Y.; Takada, T.; Kawarada, Y.; Nimura, Y.; Hirata, K.; Sekimoto, M.; Yoshida, M.; Mayumi, T.; Wada, K. (2007). "Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 15–26. doi:10.1007/s00534-006-1152-y. PMID 17252293.
  8. 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)
  9. 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)
  10. 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)
  11. 11.0 11.1 Solomkin, JS.; Mazuski, JE.; Baron, EJ.; Sawyer, RG.; Nathens, AB.; DiPiro, JT.; Buchman, T.; Dellinger, EP.; Jernigan, J. (2003). "Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections". Clin Infect Dis. 37 (8): 997–1005. doi:10.1086/378702. PMID 14523762. Unknown parameter |month= ignored (help)


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