Acute calculous cholecystitis

Diagnosis

1. RUQ pain + fever + leukocytosis associated with gallbladder inflammation
2. Ultrasound
   1. GB wall thickening (greater than 4-5mm) or edema (double wall sign)
   2. Sonographic Murphy's Sign

Treatment

1. Antibiotics
   1. Although clear evidence is lacking, assoc/ w/ decreased wnd infection and bacteremia
   2. CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)
2. Admit

Complications

1. Gangrene
   1. Occurs in 20% if untreated (esp. diabetics, elderly, delay in seeking care)
   2. Consider if pt presents with sepsis in addition to cholecystitis
2. Perforation
   1. Occurs in 2% after development of gangrene
   2. Usually localized, leading to pericholecystic abscess
3. Gallstone Ileus
   1. Due to cholecystoenteric fistula
4. Emphysematous cholecystitis
   1. Due to secondary infection of GB by gas-forming organisms
   2. Presents like cholecystitis (crepitus in abdominal wall may rarely be detected)
   3. IV abx and cholecystectomy are essential
   4. Ultrasound report may mistake GB wall gas for bowel gas

See Also

• Gallbladder Disease (Main)