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==Background==
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==Background== <!--T:1-->
 
<!--T:2-->
*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
**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


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{{Gallbladder background}}
{{Gallbladder background}}
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{{Gallbladder disease types}}
{{Gallbladder disease types}}
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===Risk Factors===
===Risk Factors=== <!--T:3-->
*[[Burns]]
 
<!--T:4-->
*[[Special:MyLanguage/Burns|Burns]]
*CAD
*CAD
*[[DM]]
*[[Special:MyLanguage/DM|DM]]
*Immunosuppression
*Immunosuppression
*[[Infection]]
*[[Special:MyLanguage/Infection|Infection]]
*[[Mechanical ventilation]]
*[[Special:MyLanguage/Mechanical ventilation|Mechanical ventilation]]
*Medications (eg, [[opioids]], sunitinib)
*Medications (eg, [[Special:MyLanguage/opioids|opioids]], sunitinib)
*Multiple [[transfusions]]
*Multiple [[Special:MyLanguage/transfusions|transfusions]]
*Nonbiliary surgery
*Nonbiliary surgery
*[[Sepsis]]/[[hypotension]]
*[[Special:MyLanguage/Sepsis|Sepsis]]/[[Special:MyLanguage/hypotension|hypotension]]
*[[Vasculitis]]
*[[Special:MyLanguage/Vasculitis|Vasculitis]]
*TPN, especially TPN > 3 mo
*TPN, especially TPN > 3 mo


==Clinical Features==
*Similar to [[calculous cholecystitis]]
*[[Jaundice]] is common (20% of patients)


==Differential Diagnosis==
==Clinical Features== <!--T:5-->
 
<!--T:6-->
*Similar to [[Special:MyLanguage/calculous cholecystitis|calculous cholecystitis]]
*[[Special:MyLanguage/Jaundice|Jaundice]] is common (20% of patients)
 
 
==Differential Diagnosis== <!--T:7-->
 
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{{DDX RUQ}}
{{DDX RUQ}}
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==Evaluation== <!--T:8-->
<!--T:9-->
[[File:PMC3236129 wjem-12-04-12-f01.png|thumb|Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]
[[File:PMC3649493 jscr-2012-2-4fig1.png|thumb|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]
===Work-Up=== <!--T:10-->
<!--T:11-->
*CBC
*Chemistry
*[[Special:MyLanguage/LFTs|LFTs]]
*Blood cultures
*[[Special:MyLanguage/RUQ Ultrasound|RUQ Ultrasound]]


==Evaluation==
===Diagnosis=== <!--T:12-->
===Work-Up===
 
<!--T:13-->
*CBC
*CBC
**Leukocytosis (70-85% of patients)
**Leukocytosis (70-85% of patients)
*Chemistry
*[[Special:MyLanguage/LFTs|LFTs]]
*[[LFTs]]
**[[Special:MyLanguage/Hyperbilirubinemia|Hyperbilirubinemia]]
**[[Hyperbilirubinemia]]
**Mildly elevated alkaline phosphatase
**Alk phos elevation (mild)
**Transaminitis
**Transaminitis
*Blood cultures
*[[Special:MyLanguage/RUQ Ultrasound|RUQ Ultrasound]]
*[[RUQ Ultrasound]]
**Absence of gallstones or sludge
**Absence of gallstones or sludge
**Thickened wall (>5 mm) with pericholecystic fluid
**Thickened wall (>5 mm) with pericholecystic fluid
**Positive sonographic Murphy's sign
**Positive sonographic Murphy's sign
**Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder
**Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder
**Frank perforation of gallbladder with associated [[abscess]] formation
**Frank perforation of gallbladder with associated [[Special:MyLanguage/abscess|abscess]] formation
 
 
==Management== <!--T:14-->


==Management==
<!--T:15-->
*[[Antibiotics]]
*[[Special:MyLanguage/Antibiotics|Antibiotics]]
**[[Ceftriaxone]] + [[metronidazole]] OR
**[[Special:MyLanguage/Ceftriaxone|Ceftriaxone]] + [[Special:MyLanguage/metronidazole|metronidazole]] OR
**[[Piperacillin/tazobactam]]
**[[Special:MyLanguage/Piperacillin/tazobactam|Piperacillin/tazobactam]]
*Cholecystectomy
*Cholecystectomy
**Definitive therapy
**Definitive therapy


==Disposition==
 
==Disposition== <!--T:16-->
 
<!--T:17-->
*Admit
*Admit


==See Also==
*[[Gallbladder Disease (Main)]]


==References==
==See Also== <!--T:18-->
 
<!--T:19-->
*[[Special:MyLanguage/Gallbladder Disease (Main)|Gallbladder Disease (Main)]]
 
 
==References== <!--T:20-->
 
<!--T:21-->
<references/>
<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Surgery]]
[[Category:Surgery]]
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Revisión actual - 16:53 6 ene 2026

Otros idiomas:

Background

  • 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
Otros idiomas:

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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.

</translate>

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.


Risk Factors


Clinical Features


Differential Diagnosis

RUQ Pain


Evaluation

Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).
CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.

Work-Up


Diagnosis

  • CBC
    • Leukocytosis (70-85% of patients)
  • LFTs
  • 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


Disposition

  • Admit


See Also


References

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