Acalculous cholecystitis: Difference between revisions
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*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis | *Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis<ref>Fu Y, et al. Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review. Dig Dis. 2022;40(4):468-478. PMID 34657038</ref> | ||
**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation | **Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation | ||
**Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality | **Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality<ref>Barie PS, Eachempati SR. Acute acalculous cholecystitis. Gastroenterol Clin North Am. 2010 Jun;39(2):343-57, x. PMID 20478490</ref> | ||
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Latest revision as of 10:56, 22 March 2026
Background
- Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis[1]
- Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
- Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality[2]
Anatomy & Pathophysiology
- Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
- These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
- Bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.
Gallbladder disease types
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Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.
- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Acute calculous cholecystitis
- Ascending cholangitis
- Acalculous cholecystitis
- Biliary atresia
- Cholestasis of pregnancy
Risk Factors
- Burns
- CAD
- DM
- Immunosuppression
- Infection
- Mechanical ventilation
- Medications (eg, opioids, sunitinib)
- Multiple transfusions
- Nonbiliary surgery
- Sepsis/hypotension
- Vasculitis
- TPN, especially TPN > 3 mo
Clinical Features
- Similar to calculous cholecystitis
- Jaundice is common (20% of patients)
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
Work-Up
- CBC
- Chemistry
- LFTs
- Blood cultures
- RUQ Ultrasound
Diagnosis
- CBC
- Leukocytosis (70-85% of patients)
- LFTs
- Hyperbilirubinemia
- Mildly elevated alkaline phosphatase
- Transaminitis
- RUQ Ultrasound
- Absence of gallstones or sludge
- Thickened wall (>5 mm) with pericholecystic fluid
- Positive sonographic Murphy's sign
- Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder
- Frank perforation of gallbladder with associated abscess formation
Management
- Antibiotics
- Cholecystectomy
- Definitive therapy
Disposition
- Admit
See Also