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Citation, DOI & article dataCitation: Radswiki, T., Vadera, S. Acute cholecystitis. Reference article, Radiopaedia.org. (accessed on 14 Oct 2022) https://doi.org/10.53347/rID-12084 Acute cholecystitis refers to the acute inflammation of the gallbladder. It is the primary complication of cholelithiasis and the most common cause of acute pain in the right upper quadrant (RUQ). On this page:Acute cholecystitis is a common cause of hospital admission and is responsible for approximately 3-10% of all patients with abdominal pain. Cholelithiasis is the major risk factor and causes up to 95% of cases.14 Other risk factors include AIDS, fibrate use, and ascariasis. Constant right upper quadrant pain that can radiate to the right shoulder. Pain typically persists for more than six hours, in contradistinction to the intermittent right upper quadrant pain of biliary colic. Nausea, vomiting, and fever are also often reported. 90-95% of cases are due to gallstones (i.e. acute calculous cholecystitis) with the remainder being acute acalculous cholecystitis. The development of acute calculous cholecystitis follows a sequence of events:
Ultrasound (US) is the preferred initial modality in the investigation of right upper quadrant pain. It is more sensitive than HIDA scintigraphy 4 and CT in the diagnosis of acute cholecystitis, and more readily available. UltrasoundThe most sensitive US finding in acute cholecystitis is the presence of cholelithiasis in combination with the sonographic Murphy sign. Both gallbladder wall thickening (>3 mm) and pericholecystic fluid are secondary findings. Other less specific findings include gallbladder distension and sludge. Every effort should be made to demonstrate the obstructing stone in the gallbladder neck or cystic duct. Nuclear medicine99mTc-HIDA scintigraphyHIDA cholescintigraphy in acute cholecystitis will demonstrate non-visualization of the gallbladder 4 hours after injection. Cholescintigraphy is unable to demonstrate many complications of cholecystitis, nor the alternative diagnoses which may be found with ultrasound. It is therefore reserved for the evaluation of sonographically equivocal cases. CTAlthough traditionally considered less sensitive than ultrasound, some reviews find CT more sensitive for this diagnosis 12,13,15. An advantage is that CT also allows better evaluation of other pathologies at the same time. CT findings include 3:
Diagnostic criteria on CT as proposed by Mirvis et al. include 6:
MRIMRI is sensitive in the detection of acute cholecystitis, with findings similar to those seen on ultrasound and CT 3. MR cholangiopancreatography (MRCP) may show an impacted stone in the gallbladder neck or cystic duct as a rounded filling defect. Treatment and prognosisUrgent surgical removal of the gallbladder is the treatment of choice for the uncomplicated disease. Gallbladder ischemia with transmural necrosis may occur if the obstruction persists. Complications
The differential diagnosis for acute cholecystitis is extensive and includes:
For a more extensive differential, please refer to the article on the differential diagnosis of diffuse gallbladder wall thickening.
Related articles: Pathology: Hepato-Pancreato-BiliaryPromoted articles (advertising)What is diagnosis of acute cholecystitis?Patients exhibiting one of the local signs of inflammation, such as Murphy's sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute ...
Which are features of acute cholecystitis?Symptoms of cholecystitis. a high temperature (fever). feeling sick.. being sick.. sweating.. loss of appetite.. yellowing of the skin and the whites of the eyes (jaundice). a bulge in the tummy.. What are the primary signs clinical signs of acute cholecystitis?Symptoms. Severe pain in your upper right or center abdomen.. Pain that spreads to your right shoulder or back.. Tenderness over your abdomen when it's touched.. Nausea.. Vomiting.. Fever.. Which are common manifestations of acute cholecystitis select all that apply?Answer: D.
Acute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following: anorexia, nausea, and vomiting.
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