Diferencia entre revisiones de «Acalculous cholecystitis»
(→DDX) |
Sin resumen de edición |
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| Línea 7: | Línea 7: | ||
*Burns | *Burns | ||
*CAD | *CAD | ||
*DM | *[[DM]] | ||
*Immunosuppression | *Immunosuppression | ||
*Infection | *Infection | ||
| Línea 18: | Línea 18: | ||
==Clinical Features== | ==Clinical Features== | ||
*Similar to calculous cholecystitis | *Similar to [[calculous cholecystitis]] | ||
*Jaundice is common (20% of pts) | *[[Jaundice]] is common (20% of pts) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Work-Up== | ==Diagnosis== | ||
===Work-Up=== | |||
*CBC | |||
*Chemistry | |||
*LFTs | |||
*Blood cx | |||
*Ultrasound | |||
== | ==Findings== | ||
*Leukocytosis (70-85% of pts) | *Leukocytosis (70-85% of pts) | ||
*LFT abnormalities | *LFT abnormalities | ||
| Línea 45: | Línea 46: | ||
==Treatment== | ==Treatment== | ||
*Abx | |||
**[[Ceftriaxone]] + metronidazole OR | |||
**Piperacillin/tazobactam | |||
*Cholecystectomy | |||
**Definitive therapy | |||
==Disposition== | ==Disposition== | ||
| Línea 57: | Línea 58: | ||
[[Gallbladder Disease (Main)]] | [[Gallbladder Disease (Main)]] | ||
== | ==References== | ||
[[Category:GI]] | [[Category:GI]] | ||
Revisión del 05:11 21 may 2015
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
Risk Factors
- Burns
- CAD
- DM
- Immunosuppression
- Infection
- Mechanical ventilation
- Medications (eg, opiates, sunitinib)
- Multiple transfusions
- Nonbiliary surgery
- Sepsis/hypotension
- Vasculitis
Clinical Features
- Similar to calculous cholecystitis
- Jaundice is common (20% of pts)
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
Diagnosis
Work-Up
- CBC
- Chemistry
- LFTs
- Blood cx
- Ultrasound
Findings
- Leukocytosis (70-85% of pts)
- 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 w/ gas bubbles arising in fundus of gallbladder
- Frank perforation of gallbladder with associated abscess formation
Treatment
- Abx
- Ceftriaxone + metronidazole OR
- Piperacillin/tazobactam
- Cholecystectomy
- Definitive therapy
Disposition
- Admit