Acute cholecystitis: Difference between revisions

Jump to navigation Jump to search
Michael (talk | contribs)
49,301 edits
redirect w/ cat.
 
Michael (talk | contribs)
49,301 edits
No edit summary
 
(20 intermediate revisions by the same user not shown)
Line 1: Line 1:
#redirect [[Gallbladder#Acute_cholecystitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Acute cholecystitis -- very low mag.jpg
| Width      =
| Caption    = Acute cholecystitis. [[H&E stain]].
| Micro      = edema, hemorrhage, +/-neutrophils, +/-reactive epithelial changes
| Subtypes  =
| LMDDx      = [[chronic cholecystitis]], [[intestinal metaplasia of the gallbladder]], [[gallbladder dysplasia]], [[adenocarcinoma of the gallbladder]]. [[eosinophilic cholecystitis]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = wall thickening (due to edema), gallstone(s) in the neck (classic finding), +/-mucosal erosions
| Grossing  = [[gallbladder grossing]]
| Site      = [[gallbladder]]
| Assdx      = [[cholelithiasis]]
| Syndromes  =
| Clinicalhx = elderly individuals (50s and 60s)
| Signs      = Murphy's sign present
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      = wall thickening (>3 mm), gallstone(s) in the neck
| Endoscopy  =
| Prognosis  = benign, good
| Other      =
| ClinDDx    =
| Tx        = cholecystectomy
}}
'''Acute cholecystitis''', abbreviated '''AC''', is a relatively uncommon [[gallbladder]] pathology when compared to [[chronic cholecystitis]]. It is usually associated with [[gallstones]] and seen in older individuals.


==General==
*Less common than ''chronic cholecystitis''.
*Usually due to gallstones.<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
*Classically older individuals (50s and 60s) with a slight female predominance.<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
Notes:
*Pathologic diagnosis very often discordant with clinical impression.<ref name=pmid8939838>{{Cite journal  | last1 = Fitzgibbons | first1 = RJ. | last2 = Tseng | first2 = A. | last3 = Wang | first3 = H. | last4 = Ryberg | first4 = A. | last5 = Nguyen | first5 = N. | last6 = Sims | first6 = KL. | title = Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis? | journal = Surg Endosc | volume = 10 | issue = 12 | pages = 1180-4 | month = Dec | year = 1996 | doi =  | PMID = 8939838 }}</ref>
==Gross==
Features:<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
*Wall thickening - due to edema and hemorrhage.†
*Gallstone(s) - classically obstructing the gallbladder neck.
*+/-Mucosal erosions.
Note:
*† The sonographic criterium for "thick" is greater than 3 mm.<ref name=pmid20223393>{{Cite journal  | last1 = Tsung | first1 = JW. | last2 = Raio | first2 = CC. | last3 = Ramirez-Schrempp | first3 = D. | last4 = Blaivas | first4 = M. | title = Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED. | journal = Am J Emerg Med | volume = 28 | issue = 3 | pages = 338-42 | month = Mar | year = 2010 | doi = 10.1016/j.ajem.2008.12.003 | PMID = 20223393 }}</ref><ref name=pmid21879282>{{Cite journal  | last1 = Kim | first1 = HJ. | last2 = Park | first2 = JH. | last3 = Park | first3 = DI. | last4 = Cho | first4 = YK. | last5 = Sohn | first5 = CI. | last6 = Jeon | first6 = WK. | last7 = Kim | first7 = BI. | last8 = Choi | first8 = SH. | title = Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening. | journal = Dig Dis Sci | volume = 57 | issue = 2 | pages = 508-15 | month = Feb | year = 2012 | doi = 10.1007/s10620-011-1870-0 | PMID = 21879282 }}</ref>
==Microscopic==
Features:<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
*Edema.
*Hemorrhage.
*+/-Fibrin thrombi in small veins.
*+/-Mucosal erosions.
*+/-[[Neutrophils]] - '''useful'''
**Not essential for the Dx of ''acute cholecystitis''.
**Neutrophils usually secondary to [[necrosis]]/ulceration or infection.<ref name=Ref_DCHH174>{{Ref DCHH|174}}</ref>
*+/-Reactive epithelial changes.<ref name=Ref_GLP439>{{Ref GLP|439}}</ref>
Notes:
*May see activated fibroblasts.
DDx:
*[[Chronic cholecystitis]] - has less inflammation, fibrotic wall thickening/muscular hypertrophy, may have RK sinuses.
*[[Gallbladder adenocarcinoma]].
*[[Intestinal metaplasia of the gallbladder]].
*[[Eosinophilic cholecystitis]] - has >90% eosinophils.
===Images===
<gallery>
Image: Acute cholecystitis -- very low mag.jpg | AC - very low mag.
Image: Acute cholecystitis -- low mag.jpg | AC - low mag.
Image: Acute cholecystitis -- intermed mag.jpg | AC - intermed. mag.
Image: Acute cholecystitis - a -- intermed mag.jpg | AC - intermed. mag.
Image: Acute cholecystitis - b -- intermed mag.jpg | AC - intermed. mag.
</gallery>
===Special types===
====Gangrenous cholecystitis====
General:<ref name=pmid21762298>{{Cite journal  | last1 = Nikfarjam | first1 = M. | last2 = Niumsawatt | first2 = V. | last3 = Sethu | first3 = A. | last4 = Fink | first4 = MA. | last5 = Muralidharan | first5 = V. | last6 = Starkey | first6 = G. | last7 = Jones | first7 = RM. | last8 = Christophi | first8 = C. | title = Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. | journal = HPB (Oxford) | volume = 13 | issue = 8 | pages = 551-8 | month = Aug | year = 2011 | doi = 10.1111/j.1477-2574.2011.00327.x | PMID = 21762298 }}</ref>
*Older.
*Clinically "sicker".
*Worse outcome than (acute) non-gangrenous cholecystitis.
Microscopic:
*[[Necrosis]] of gallbladder wall (muscularis propria).<ref>Struetker C. 25 February 2009.</ref>
==Sign out==
<pre>
Gallbladder, Cholecystectomy:
- Acute cholecystitis with cholelithiasis.
</pre>
=====Block letters=====
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE CHOLECYSTITIS.
- CHOLELITHIASIS.
</pre>
====Necrosis of wall====
<pre>
Gallbladder, Cholecystectomy:
- Acute cholecystitis with multiple mucosal erosions and focal necrosis of the gallbladder wall.
</pre>
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE AND CHRONIC CHOLECYSTITIS WITH MULTIPLE MUCOSAL EROSIONS AND FOCAL
  NECROSIS OF THE GALLBLADDER WALL.
</pre>
====Gangrenous cholecystitis====
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- GANGRENOUS CHOLECYSTITIS.
- CHOLELITHIASIS.
</pre>
<pre>
Gallbladder, Cholecystectomy:
- Gangrenous (acute) cholecystitis with cholelithiasis.
</pre>
====Xanthomatous lymph node present====
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE CHOLECYSTITIS.
- CHOLELITHIASIS.
- BENIGN LYMPH NODE WITH NONNECROTIZING GRANULOMAS, XANTHOMATOUS APPEARANCE.
- NEGATIVE FOR DYSPLASIA.
</pre>
===Micro===
The sections show gallbladder wall with hemorrhage, and activated fibroblasts.  The superficial mucosa has clusters of neutrophils.
====Alternate====
The sections show an inflamed gallbladder wall with hemorrhage, activated fibroblasts and focal
necrosis. The mucosa is partially eroded. Abundant neutrophils and eosinophils are present. No significant nuclear changes are apparent.
==See also==
*[[Chronic cholecystitis]].
*[[Gallbladder]].
==References==
{{Reflist|2}}
[[Category:Gallbladder]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
Retrieved from "https://librepathology.org/wiki/Acute_cholecystitis"