|Print Date:||May 19, 2013, 10:53 am|
|Text||Acute cholecystitis typically presents with right upper quadrant or periumbilical abdominal pain that may radiate to the back or shoulder, fever, and leukocytosis. The gallbladder becomes inflamed due to blockage of the cystic duct--not all gallstones produce enough irritation to produce inflammation. Many people with gallstones are asymptomatic, some have episodes of biliary colic, and others develop cholecystitis.
The diagnosis is most commonly made via ultrasound, which may show presence of gallstones, gallbladder wall thickening, and/or pericholic fluid. Studies have shown that US is fairly sensitive in >80% of cases. One study reported by M.T. Keogan suggested that MRCP with half-Fourier RARE sequence has a sensitivity of 91% and specificity of 79% for acute cholecystitis though other studies suggest lower sensitivity (70%). For detection of stones in the cystic duct, however, MRCP is indisputably more reliable than ultrasound; with reported sensitivity and specificity of 95 and 97 percent. ERCP has, in the past, been commonly used for visualization of the ductal system and is useful for concurrent stone extraction, stent insertion, or biopsy. But MRCP has become useful because it is less invasive and does not require addition of contrast--hence decreasing procedure morbidity.
Left untreated, cholecystitis may resolve. But due to the various complications which can occur such as gallbladder gangrene, perforated gallbladder, or cholecystoenteric fistula leading to gallstone ileus, removal of the gallbladder is the preferred method of treatment and is commonly performed via laparoscopic method converted to open cholecystectomy as needed.
|References:||Indar, Adran A. "Acute Cholecystitis," BMJ 2002:325:639-643 (21 Sept).
Keogan, Mary T and Edelman, Robert R. "Technologic Advances in Abdominal MR Imaging," Radiology. 2001:220:310-320.
|Contributor||Russell A. Patterson (Uniformed Services University)|
|Author||ENS Gail Bates|
|Peer Reviewer||Julian Paul Kassner (National Naval Medical Center Bethesda)|
|Record Number||: 6397|
|Category:||Clinical Exam Finding or Sign|
|MedPix® Medical Image Database |
Content Text and Images may be Copyright © 1999 - 2006 by the Original Contributors