Acute Cholecystitis


Article Author:
Mark Jones
Rafaella Genova


Article Editor:
Maria O'Rourke


Editors In Chief:
Jasleen Jhajj
Cliff Caudill
Evan Kaufman


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
8/10/2019 5:46:47 PM

Introduction

Acute cholecystitis refers to inflammation of the gallbladder. The pathophysiologic mechanism of acute cholecystitis is blockage of the cystic duct. Cholecystitis is a condition best treated with surgery, however, it can be treated conservatively if necessary. This condition can be associated with or without the presence of gallstones. It is also classified as acute or chronic. It is found both in men and women but may have a propensity for certain populations. It may also present with certain classic signs and symptoms. It may also be confused with other illnesses such as peptic ulcer disease, irritable bowel disease, and cardiac disease. Chronic and acute pancreatitis can also mimic gallbladder disease.[1][2][3]

Etiology

The etiology of acute cholecystitis is by definition cystic duct blockage, which causes inflammation. Normally, bile is made in the liver and travels down the bile duct and is stored in the gallbladder. After eating certain foods, especially spicy or greasy foods, the gallbladder is stimulated to empty the bile out of the gallbladder, through the cystic duct, down the bile duct into the duodenum. This process aids in food digestion.

The gallbladder not only stores the bile, but it also has the ability to concentrate it. Concentrated bile is susceptible to precipitation forming stones when homeostasis is disrupted, that can occur due to bile stasis, supersaturation from the liver of cholesterol and lipids, disruption in the concentration process, and cholesterol crystal nucleation. 

When cystic duct blockage is caused by a stone, it is called acute calculous cholecystitis. It is important to know, one can have pain due to temporary obstruction by gallstones, and that is called biliary cholic. The diagnosis of biliary cholic is upgraded to acute calculous cholecystitis if the pain does not resolve for >6 hours. If no stone is identified, it is called acute acalculous cholecystitis.[4][5]

Regardless of the cause of the blockage, the gallbladder wall edema will eventually cause wall ischemia and become gangrenous. The gangrenous gallbladder can become infected by gas forming organism, causing acute emphysematous cholecystitis; all of these conditions can quickly become life-threatening, and rupture has a high rate of mortality. 

About 95% of people with acute cholecystitis have gallstones. [6] However that does not mean incidental findings of gallstone should be treated, as it is estimated that only 20% of patients with asymptomatic stones will develop symptoms within 20 years[7], and because approximately 1% of patients with asymptomatic stones develop complications of their stones before the onset of symptoms, prophylactic cholecystectomy is not warranted in asymptomatic patients. 

Epidemiology

Gallbladder disease occurs in men and women. Certain populations are more prone to gallbladder disease. The risk of gallbladder disease increases in women, obese patients, pregnant women, and patients in their 40s. Drastic weight loss or acute illnesses may also increase the risk. There is also a family propensity for this condition and the formation of gallstones. Other conditions that cause breakdown of blood cells, for example, sickle cell disease, also increase the incidence of gallstones.

Pathophysiology

Occlusion of the cystic duct or malfunction of the mechanics of the gallbladder emptying is the pathophysiology of this disease. Cases of acute untreated cholecystitis could lead to perforation of the gallbladder, sepsis, and death. Gallstones form from various materials such as bilirubinate or cholesterol. These materials increase the likelihood of cholecystitis and cholelithiasis in conditions such as sickle cell disease where red blood cells are broken down forming excess bilirubin and forming pigmented stones. Patients with excessive calcium such as in hyperparathyroidism can form calcium stones. Patients with excessive cholesterol can form cholesterol stones. Occlusion of the common bile duct such as in neoplasms or strictures can also lead to stasis of the bile flow causing gallstone formation.[8][9]

Histopathology

During the early phase, the gallbladder will usually reveal extensive venous congestion and edema. With time, fibrosis and presence of chronic inflammatory cells may appear. More advanced cases may reveal the presence of perforation or gangrene.

History and Physical

Cases of chronic cholecystitis present with progressing right upper abdominal pain with bloating, food intolerances (especially greasy and spicy foods), increased gas, nausea, and vomiting. Pain in the midback or shoulder may also occur. This pain could be present for years until diagnosis. Cases of acute cholecystitis have similar symptoms only more severe. Often symptoms are mistaken for cardiac issues. The finding of right upper abdominal pain with deep palpation, Murphy's sign, is usually classic for this disease. Often, there is a specific dietary event leading to the acute attack, "I ate pork chops and gravy last night."

Evaluation

A physical exam with a comprehensive history is paramount in making the diagnosis of cholecystitis. A complete blood count (CBC) and a comprehensive metabolic panel are also important. In cases of chronic cholecystitis, these results may be normal. In acute cholecystitis or severe disease, white blood cell count (WBC) may be elevated. Liver enzymes may also be elevated. If there is a high bilirubin level above 2, then consider a possible common bile duct stone. Note that even in the presence of severe gallbladder disease, lab values may be normal. Amylase and lipase must also be checked to rule out pancreatitis. Often a CT scan is ordered in the emergency department as the first test in the work up. Findings of cholecystitis and gallstones can often be seen on this imaging. A gallbladder ultrasound is the best test to evaluate gallbladder disease initially. A thickened gallbladder wall and gallstones are common findings with this condition. In cases of acute cholecystitis, a hepatobiliary (HIDA) scan is recommended. This scan will diagnose gallbladder function or cystic duct obstruction. The addition of cholecystokinin (CCK) in cases of no gallstones may also diagnose acalculous cholecystitis. This is indicated by an ejection fracture less than 35%.[10][11]

Treatment / Management

The best treatment for cholecystitis is laparoscopic cholecystectomy. There are low morbidity and mortality rates with quick recovery. This can also be done with an open technique in cases where the patient is not a good laparoscopic candidate. In situations in which the patient is acutely ill and considered a poor surgical candidate, he or she may be treated with temporizing percutaneous drainage of the gallbladder. Milder cases of chronic cholecystitis in patients considered poor surgical candidates, they may be treated with dietary adjustments of low-fat and low-spice diets. Results of this treatment vary. Medical treatment of gallstones with ursodiol also has been reported to have occasional success.[12][13][3]

Differential Diagnosis

  • Appendicitis
  • Biliary colic
  • Cholangitis
  • Mesenteric ischemia
  • Gastritis
  • Peptic ulcer disease

Complications

  • Biloma
  • Intraabdominal Abscess 
  • Bile Duct injury
  • Hepatic Injury
  • Small bowel injury
  • Infection
  • Retained stones in the bile duct
  • Bleeding

Postoperative and Rehabilitation Care

Once the gallbladder has been removed, most patients can be discharged on the same day.

The pain is minimal and can be managed by over the counter analgesics. The patient may complain of severe shoulder pain due to retained CO2 from laparoscopic insufflation and should be explained that such pain will dissipate as patient moves and gas is slowly absorbed, which can take up to 3 days.

Prior to discharge, the patient should be advised on possible intolerance to greasy food, which may cause bloating and/or diarrhea.  This can be temporary or at some degree permanent, due to the decrease speed of fat emulsification by the loss of stored bile in the gallbladder. Most patient will have an up-regulation in bile production by the liver and will see improvement in symptoms with time. 

Follow up time is between 3-4 weeks from operation. 

Deterrence and Patient Education

1. Patient education: Gallbladder removal (cholecystectomy) (The Basics)- Uptodate 

2. Patient education: Gallstones (The Basics)- Uptodate 

 

Pearls and Other Issues

Cholecystitis can occur in the very young and very old, but the highest incidence is in the fourth decade. The classic mantra of "fat, forty, fertile, and flatulent" often applies. Food intolerances are usually the initiating factor of nausea, vomiting, and bloating, but as this condition progresses, there may be persistent symptoms even when the patient has not eaten. The preferred recommended treatment is the removal of the gallbladder. In the past, this was done through an open laparotomy incision. Now laparoscopic cholecystectomy is the procedure of choice. This procedure has low mortality and morbidity, a quick recovery time (usually one week), and good results. At times, patients present to the primary care practitioner with mild symptoms of cholecystitis and gallstones. This can present a challenge to the physician to know what is the appropriate treatment. Often conservative medical management is recommended. This would include low-fat diet modification and possible weight loss. Unfortunately, for surgeons, these patients often present to the emergency department with symptoms of acute cholecystitis and undergo urgent surgery. This situation also increases operative morbidity rates. Therefore, general surgeons usually recommend patients undergo elective laparoscopic cholecystectomy earlier than later in the course of the disease. Other considerations would be the passing of gallstones into the bile duct causing biliary obstruction and possible pancreatitis.

Enhancing Healthcare Team Outcomes

Managing acute cholecystitis is now routine, and most patients have an excellent prognosis. However, problems arise in patients with acalculous cholecystitis and when there are bile duct stones. Patients with acalculous cholecystitis are often managed in the ICU and may undergo an initial aspiration procedure until they are fit to undergo formal surgery. Since many of these patients have high comorbidity, monitoring them is critical. Educating the patient and family is vital since the condition does carry a high mortality. The other group of patients who may have a prolonged stay are those with a bile duct stone. These patients require an ERCP prior to the cholecystectomy. Again ERCP is not a benign procedure, and patients need to be educated about the procedure and potential complications. 

Patients with numerous comorbid factors need to be evaluated by the cardiologist prior to general anesthesia. The preoperative nurse should ensure that the patient has the requisite clearance, ECG, Chest x-ray, and blood work prior to the surgery. if there are any deficiencies or concerns the surgeon should be contacted prior to the procedure.[14][15][16] (Level V) After the procedure, the nurse will monitor vital signs and assist in managing the patient's pain. If there is any significant change in vital signs or the pain cannot be controlled with the medications provided, the surgeon should be consulted. Pre-operatively, the pharmacist should access the patient's medications and make sure that there is no concern for withdrawal or potential interaction with the anesthetics. The clinical team should be apprised if there are any concerns.

Outcomes

For patients with uncomplicated acute cholecystitis, the prognosis is excellent. The mortality rates are very low. Perforation or gangrene of the gallbladder may occur in delayed cases. Patients with acalculous cholecystitis have a high mortality varying from 20-50%.

In severe cases of acute cholecystitis, the intense inflammation can make surgery difficult, resulting in injury to the bile duct, which has a substantial morbidity.[17][18] (Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Acute Cholecystitis - Questions

Take a quiz of the questions on this article.

Take Quiz
A 42-year-old female presents to the emergency department with persistent epigastric abdominal pain for the past 10 hours while she was at a barbecue party. She also complains of nausea and bloating. The patient states experiencing similar symptoms in the past; however, they were self resolved. All laboratory results were normal. Abdominal ultrasound revealed a thickened gallbladder wall with pericholecystic fluid, gallstones, and positive murphy's sign. Which of the following is the best treatment for this condition?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 27-year-old female who is 24 weeks pregnant, presents to the emergency department with severe right upper quadrant pain for the past 10 hours, accompanied by nausea and anorexia. The patient's white blood count is slightly elevated and she is afebrile. Fetal heart rate and uterine activity are normal and the pelvic exam is unremarkable. Abdominal ultrasound demonstrates gallstones with a thickened gallbladder wall and the biliary duct does not appear to be dilated. What is the best next step of treatment?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 65-year-old male with a past medical history of uncontrolled diabetes presents to the emergency department with mild abdominal tenderness and altered mental status. Patient's temperature is 103.4 F, heart rate 105 bpm, blood pressure 90/55 mmHg, respiratory rate 22/min, white blood count 18,000 mm3, and lactic acid 1.5 mmol/L. The physical examination is notable for mild tenderness to palpation on the right upper quadrant (RUQ). The patient is transferred to the intensive care unit (ICU). Blood cultures are sent, and the patient is started on a broad-spectrum antibiotic. A computed tomography (CT) abdomen/pelvis demonstrated a distended gallbladder without duct dilatation. Surgery is consulted, and due to the patient's instability, a percutaneous cholecystostomy tube (PCT) is recommended. What is the most common organism isolated in a high-risk patient with acute cholecystitis who requires PCT?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 56-year-old female is referred to the surgical clinic after she was found to have gallstones on abdominal imaging. Patient denies abdominal pain, discomfort with food intake, dark urine, or pale stool. Patient's complete blood count (CBC), basic metabolic panel (BMP), and liver function test (LFT) are unremarkable. What is her risk of developing acute cholecystitis as a primary presentation, in the next 20 years?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 51-year-old woman presents to the emergency department complaining of right upper quadrant, colicky abdominal pain onset two days ago. The patient states the pain has become constant for the past 8 hours, urging her to seek medical attention. The patient also complains of nausea and vomiting. During the physical exam, palpation to the right upper quadrant elicits pain. The patient's white blood count is 18,000 mm3, alkaline phosphatase (ALP) 55 IU/L, alanine aminotransferase (ALT) 30 IU/L, aspartate aminotransferase (AST) 40 IU/L, total bilirubin 1mg/dL, and lipase is 105 IU/L. What is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 35-year-old female presents to the emergency department complaining of the acute right upper quadrant (RUQ) pain onset last night. The patient states pain started after eating two hotdogs. The patient has taken antiacid medication without relief. She is otherwise healthy, and only past surgical history is 4 prior cesarian section. The emergency medicine physician discusses with the patient their high level of suspicion for acute cholecystitis based on her presentation. What is the most sensitive test for diagnosing the patient's condition?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 50-year-old female presented to the emergency department complaining of right upper quadrant abdominal pain onset one day ago. Labs reveal a mild elevation on liver function test (LFT) and normal total bilirubin. An abdominal ultrasound is ordered, demonstrating cholelithiasis with 6mm gallbladder wall, pericholecystic fluid, and 9mm common bile duct (CBD). The patient was taken to the operating room for cholecystectomy and intraoperative cholangiogram. Initial cholangiogram demonstrated a filling defect. After administration of an IV medication, CBD is clearly visualized, without filling the defect, and contrast reaches the duodenum. Which of the following medication was administered?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 74-year-old presents with acute cholecystitis. She is diabetic and has been on steroids for rheumatoid arthritis. Which of the following is most appropriate for the management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 43-year-old female presents to the emergency department with right upper quadrant pain and is found to have gallstones. Which of the following drugs can make her biliary discomfort worse?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 44-year-old patient with a known history of alcohol use averaging 9 drinks a day is admitted for midepigastric pain. Surgery is subsequently planned for cholecystectomy. Which of the following should NOT be included in preoperative treatment?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with right sided abdominal pain ceases respiratory effort with deep palpation to the right upper quadrant. Select the most likely diagnosis.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the most appropriate evaluation for gallbladder disease.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 52-year-old female complains of an 8-hour history of nausea and right upper quadrant pain. She has no significant past medical history. The patient has a low-grade fever and rebound tenderness in the right upper quadrant. White blood cell count is 11,000/mm3, liver functions are normal, and urinalysis is normal. What is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A physician requests a 99mTc-albumin colloid scan to rule out acute cholecystitis. What should be the practitioner's response?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 16-year-old female is eight weeks postpartum. She complains of right upper quadrant abdominal pain, nausea, and vomiting. The patient is jaundiced and tender at the right upper quadrant. Lungs are clear and the chest X-ray is normal. Select the appropriate diagnostic test.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents with right upper quadrant pain, nausea, and vomiting. She is febrile, but the rest of the vital signs are normal. Exam and radiologic studies confirm acute cholecystitis. Pain medication is administered. What is the best next step in management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 74-year-old female with type 2 diabetes mellitus presents with generalized abdominal pain for 12 hours. She denies vomiting, diarrhea, hematemesis, hematochezia, or melena. Vital signs are normal. Abdominal exam shows decreased bowel sounds but no rebound, guarding, masses, or hepatosplenomegaly. Rectal exam shows no masses and is guaiac negative. WBC is 13,500 cells/microL. KUB is unremarkable and ultrasound of the gallbladder is inconclusive as it is obscured by bowel gas. Select the next step in management.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which disease process presents with positive Murphy sign?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In which situation is an open cholecystectomy most likely to be preferred over a laparoscopic cholecystectomy?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 9 year old female with sickle cell anemia presents with nausea, abdominal pain, and vomiting for 10 hours. She has had several similar episodes that had resolved within a few hours. The patient is slightly jaundiced and tender at the right upper quadrant. Select the most sensitive and specific test for diagnosis.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 45-year-old woman with acute upper abdominal pain is asked to take a deep breath as an examiner's fingers are inserted deeply under the right costal margin. The patient suddenly stops inspiring because of sharp pain. Which of the following is most likely?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A female presents with right upper quadrant pain and fever. She has been nauseated for the past 2 days and has no appetite. It is suspected that she may have acute cholecystitis. Which of the following is not a criterion for acute cholecystitis on ultrasound?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents with cholecystitis and referred pain. Where would the referred pain most often be located?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient arrives in the emergency department with right upper quadrant abdominal pain, nausea, and vomiting after eating fried chicken the night before. The provider orders an abdominal ultrasound and lab work. Which findings would the nurse expect with these presenting symptoms? Select all that apply.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Acute Cholecystitis - References

References

Burmeister G,Hinz S,Schafmayer C, [Acute Cholecystitis]. Zentralblatt fur Chirurgie. 2018 Aug     [PubMed]
Walsh K,Goutos I,Dheansa B, Acute Acalculous Cholecystitis in Burns: A Review. Journal of burn care     [PubMed]
Kohga A,Suzuki K,Okumura T,Yamashita K,Isogaki J,Kawabe A,Kimura T, Is postponed laparoscopic cholecystectomy justified for acute cholecystitis appearing early after onset? Asian journal of endoscopic surgery. 2018 Mar 25     [PubMed]
Yun SP,Seo HI, Clinical aspects of bile culture in patients undergoing laparoscopic cholecystectomy. Medicine. 2018 Jun     [PubMed]
Wilkins T,Agabin E,Varghese J,Talukder A, Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia. Primary care. 2017 Dec     [PubMed]
Apolo Romero EX,Gálvez Salazar PF,Estrada Chandi JA,González Andrade F,Molina Proaño GA,Mesías Andrade FC,Cadena Baquero JC, Gallbladder duplication and cholecystitis. Journal of surgical case reports. 2018 Jul     [PubMed]
Sureka B,Rastogi A,Mukund A,Thapar S,Bhadoria AS,Chattopadhyay TK, Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases. The Indian journal of radiology     [PubMed]
Tootian Tourghabe J,Arabikhan HR,Alamdaran A,Zamani Moghadam H, Emergency Medicine Resident versus Radiologist in Detecting the Ultrasonographic Signs of Acute Cholecystitis; a Diagnostic Accuracy Study. Emergency (Tehran, Iran). 2018     [PubMed]
Joshi G,Crawford KA,Hanna TN,Herr KD,Dahiya N,Menias CO, US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease. Radiographics : a review publication of the Radiological Society of North America, Inc. 2018 May-Jun     [PubMed]
Thangavelu A,Rosenbaum S,Thangavelu D, Timing of Cholecystectomy in Acute Cholecystitis. The Journal of emergency medicine. 2018 Jun     [PubMed]
Ke CW,Wu SD, Comparison of Emergency Cholecystectomy with Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Patients with Moderate Acute Cholecystitis. Journal of laparoendoscopic     [PubMed]
Yeh DD,Chang Y,Tabrizi MB,Yu L,Cropano C,Fagenholz P,King DR,Kaafarani HMA,de Moya M,Velmahos G, Derivation and validation of a practical Bedside Score for the diagnosis of cholecystitis. The American journal of emergency medicine. 2018 Apr 25     [PubMed]
Gulaya K,Desai SS,Sato K, Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice. Seminars in interventional radiology. 2016 Dec     [PubMed]
Bagla P,Sarria JC,Riall TS, Management of acute cholecystitis. Current opinion in infectious diseases. 2016 Oct     [PubMed]
Kohga A,Suzuki K,Okumura T,Yamashita K,Isogaki J,Kawabe A,Kimura T, Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution. Asian journal of endoscopic surgery. 2018 Apr 3     [PubMed]
Ahmed O,Rogers AC,Bolger JC,Mastrosimone A,Lee MJ,Keeling AN,Cheriyan D,Robb WB, Meta-analysis of outcomes of endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for the management of acute cholecystitis. Surgical endoscopy. 2018 Apr     [PubMed]
Halpin V, Acute cholecystitis. BMJ clinical evidence. 2014 Aug 20     [PubMed]
Behari A,Kapoor VK, Asymptomatic Gallstones (AsGS) - To Treat or Not to? The Indian journal of surgery. 2012 Feb     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Optometry-Basic Science. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Optometry-Basic Science, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Optometry-Basic Science, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Optometry-Basic Science. When it is time for the Optometry-Basic Science board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Optometry-Basic Science.