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Acalculous Cholecystitis

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Acalculous Cholecystitis, Biliary Dyskinesia

  • Epidemiology
  1. Incidence: 5-10% of patients with Acute Cholecystitis
  2. Most common in critically ill intensive Care patients
  • Risk factors
  1. Elderly
  2. Diabetes Mellitus
  3. Multiple Trauma
  4. Extensive Burn Injury
  5. Prolonged labor
  6. Major surgery
  7. Gallbladder torsion
  8. Systemic Vasculitis
  9. Biliary tract infection (Bacterial or parasitic)
  • Findings
  • Symptoms and Signs
  1. Indistinguishable from calculous Acute Cholecystitis
  2. Patient ill on initial presentation
  3. Presentation may be subtle in already ill ICU patients
    1. May present as Fever Without Source
  • Imaging
  1. RUQ Ultrasound or CT Abdomen
    1. Large, tense, static gallbladder
    2. No evidence of Gallstones
  2. Radionuclide Cholescintography (HIDA Scan)
    1. Poor gallbladder filling
    2. Gallbladder ejection fraction <50%
  • Management
  • Prognosis
  1. Intensive care patient
    1. Delayed diagnosis is common, often with gall bladded gangrene or perforation at time of diagnosis
    2. Mortality 10-50%
  2. Outpatient diagnosis in an otherwise healthy patient
    1. Follows a typical course as those with typical Cholecystitis
  • References
  1. Aldeen and Rosenbaum (2017) 1200 Questions Emergency Medicine Boards, 3rd ed, Wolters Kluwer, Baltimore, p. 122