Difference between revisions of "Acute cholecystitis"

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| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      = wall thickening (due to edema), gallstone(s) in the neck (classic finding)
| Gross      = wall thickening (due to edema), gallstone(s) in the neck (classic finding), +/-mucosal erosions
| Grossing  =
| Grossing  =
| Site      = [[gallbladder]]
| Site      = [[gallbladder]]
| Assdx      =
| Assdx      = choledocholithiasis
| Syndromes  =
| Syndromes  =
| Clinicalhx = elderly individuals (50s and 60s)
| Clinicalhx = elderly individuals (50s and 60s)
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*Wall thickening - due to edema and hemorrhage.†
*Wall thickening - due to edema and hemorrhage.†
*Gallstone(s) - classically obstructing the gallbladder neck.
*Gallstone(s) - classically obstructing the gallbladder neck.
*+/-Mucosal erosions.


Note:
Note:

Revision as of 15:33, 27 September 2013

Acute cholecystitis
Diagnosis in short
LM edema, hemorrhage, +/-neutrophils, +/-reactive epithelial changes
LM DDx chronic cholecystitis, intestinal metaplasia of the gallbladder, gallbladder dysplasia, adenocarcinoma of the gallbladder
Gross wall thickening (due to edema), gallstone(s) in the neck (classic finding), +/-mucosal erosions
Site gallbladder
Associated Dx choledocholithiasis
Clinical history elderly individuals (50s and 60s)
Prevalence uncommon
Radiology wall thickening (>3 mm), gallstone(s) in the neck
Prognosis benign, good

Acute cholecystitis 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.[1]
  • Classically older individuals (50s and 60s) with a slight female predominance.[1]

Notes:

  • Pathologic diagnosis very often discordant with clinical impression.[2]

Gross

Features:[1]

  • 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.[3][4]

Microscopic

Features:[1]

  • 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.[5]
  • +/-Reactive epithelial changes.[6]

Notes:

  • May see activated fibroblasts.

DDx:

Special types

Gangrenous cholecystitis

General:[7]

  • Older.
  • Clinically "sicker".
  • Worse outcome than (acute) non-gangrenous cholecystitis.

Microscopic:

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GALLBLADDER, CHOLECYSTECTOMY: 
- ACUTE CHOLECYSTITIS.
- CHOLELITHIASIS.

GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE AND CHRONIC CHOLECYSTITIS WITH MULTIPLE MUCOSAL EROSIONS AND FOCAL NECROSIS OF THE GALLBLADDER WALL.

GALLBLADDER, CHOLECYSTECTOMY:
- GANGRENOUS CHOLECYSTITIS.
- CHOLELITHIASIS.

Micro

The sections show gallbladder wall with hemorrhage, and activated fibroblasts. The superficial mucosa has clusters of neutrophils.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 1606. ISBN 978-0781779425. Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content
  2. ↑ Fitzgibbons, RJ.; Tseng, A.; Wang, H.; Ryberg, A.; Nguyen, N.; Sims, KL. (Dec 1996). "Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis?". Surg Endosc 10 (12): 1180-4. PMID 8939838.
  3. ↑ Tsung, JW.; Raio, CC.; Ramirez-Schrempp, D.; Blaivas, M. (Mar 2010). "Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED.". Am J Emerg Med 28 (3): 338-42. doi:10.1016/j.ajem.2008.12.003. PMID 20223393.
  4. ↑ Kim, HJ.; Park, JH.; Park, DI.; Cho, YK.; Sohn, CI.; Jeon, WK.; Kim, BI.; Choi, SH. (Feb 2012). "Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.". Dig Dis Sci 57 (2): 508-15. doi:10.1007/s10620-011-1870-0. PMID 21879282.
  5. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 174. ISBN 978-0470519035.
  6. ↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 439. ISBN 978-0443066573.
  7. ↑ Nikfarjam, M.; Niumsawatt, V.; Sethu, A.; Fink, MA.; Muralidharan, V.; Starkey, G.; Jones, RM.; Christophi, C. (Aug 2011). "Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis.". HPB (Oxford) 13 (8): 551-8. doi:10.1111/j.1477-2574.2011.00327.x. PMID 21762298.
  8. ↑ STC. 25 February 2009.
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