Gallbladder disease (main): Difference between revisions
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==DDX==
<languages/>
#Cholecystitis
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#Cholangitis
#Symptomatic Cholelithiasis


==Acute Cholecystitis==
==Background==


===Diagnosis===
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# RUQ pain + fever + leukocytosis associated with gallbladder inflammation
{{Gallbladder disease types}}
# Ultrasound
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## GB wall thickening (greater than 4-5mm) or edema (double wall sign)
## Sonographic Murphy's Sign


===Treatment===
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# Antibiotics
{{Gallbladder background}}
## Although clear evidence is lacking, assoc/ w/ decreased wnd infection and bacteremia
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## CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)
# Admit


===Complications===
# Gangrene
## Occurs in 20% if untreated (esp. diabetics, elderly, delay in seeking care)
## Consider if pt presents with sepsis in addition to cholecystitis
# Perforation
## Occurs in 2% after development of gangrene 
## Usually localized, leading to pericholecystic abscess
# Gallstone Ileus
## Due to cholecystoenteric fistula
# Emphysematous cholecystitis
## Due to secondary infection of GB by gas-forming organisms
## Presents like cholecystitis (crepitus in abdominal wall may rarely be detected)
## IV abx and cholecystectomy are essential
## Ultrasound report may mistake GB wall gas for bowel gas
==Cholangitis==
===Diagnosis===
# Charcot's Triad: Fever + jaundice + RUQ pain
## Occurs in 50-75%
# Reynold's Pentad: The triad + AMS + hypotension
## Hypotension may be the only presenting sign in elderly pts
# Labs
## Leukocytosis with neutrophil predominance
## Elevated alk phos, conj. bilirubin
## Blood culture is indicated
# Imaging
## Ultrasound
### Dilatation of CBD ( > 6mm) and presence of choledocholithiasis
### May miss small CBD stones and in acute cases CBD may not have had time to dilate
# ERCP
## Should be obtained to confirm the diagnosis and to intervene


===Treatment ===
==Clinical Features==
# Broad-spectrum parenteral Abx covering gram - and anerobes
## CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)
==Symptomatic Cholelithiasis==
===Diagnosis===
# History
## RUQ pain that is usually constant, not colicky
## Usually does not occur during fasting
# Physical Exam
## Often benign; as compared to cholecystitis, usually negative Murphy's Sign
# Labs
## LFT, CBC normal
# Ultrasound
## Sensitivity 84%, Specificity 99%


===Treatment===
*[[Special:MyLanguage/RUQ pain|RUQ pain]]
# IV/IM Ketorolac (as effective as meperidine) with Rx for Ibuprofen
*Additional features vary by pathology


==Source==
 
UpToDate
==Differential Diagnosis==
 
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{{DDX RUQ}}
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==Evaluation==
 
*CBC
*Chemistry
*[[Special:MyLanguage/LFTs|LFTs]]
*Lipase
*PT/PTT
*[[Special:MyLanguage/Biliary ultrasound|Biliary ultrasound]]
 
 
==Management==
 
*[[Special:MyLanguage/Analgesia|Analgesia]] PRN
*Management varies per specific pathology
 
 
==Disposition==
 
*Dependant on pathologic process
 
 
==See Also==
 
*[[Special:MyLanguage/Biliary ultrasound|Biliary ultrasound]]
*[[Special:MyLanguage/Abdominal Pain|Abdominal Pain]]
 
 
==References==
 
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:Surgery]]
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Latest revision as of 22:55, 4 January 2026


Background

Gallbladder disease types

Gallbladder anatomy (overview).
Gallbladder anatomy
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.


<translate>

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.

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Clinical Features

  • RUQ pain
  • Additional features vary by pathology


Differential Diagnosis

RUQ Pain


Evaluation


Management

  • Analgesia PRN
  • Management varies per specific pathology


Disposition

  • Dependant on pathologic process


See Also


References

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