Acalculous cholecystitis

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  • Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
    • Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
    • Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality

Anatomy & Pathophysiology

Gallbladder anatomy
  • 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

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

Differential Diagnosis

RUQ Pain



  • CBC
  • Chemistry
  • LFTs
  • Blood cultures
  • RUQ Ultrasound


  • Leukocytosis (70-85% of patients)
  • LFT abnormalities
    • Hyperbilirubinemia
    • Alk phos elevation (mild)
    • Transaminitis
  • Ultrasound findings:
    • 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



  • Admit

See Also

Gallbladder Disease (Main)