Curriculum · Gastroenterology
Acute cholecystitis
What it is
Fever, leukocytosis and elevated liver enzymes turn biliary pain into acute cholecystitis; the same three also indicate obstruction of the common bile duct. Cholelithiasis is the usual finding under it. Acalculous cholecystitis is the form without stones. It occurs more prominently in critically ill patients, in the ICU, with prolonged fasting, trauma or burns, and has high mortality. It is named when a critically ill, febrile or septic patient has no gallstones on the sonogram but findings otherwise compatible.
How it presents
Biliary pain is characterized by the episodic onset of acute, severe, epigastric or RUQ pain. Episodes generally last 15 minutes to several hours and are often accompanied by nausea and vomiting. What marks the acute episode is pain that persists and does not respond to analgesics. In the pattern given for acute cholecystitis, bilirubin is under 4 mg/dL. The differential is acute pancreatitis, liver abscess and acute pyelonephritis, and acute pancreatitis has to be ruled out even when acute cholecystitis looks sure.