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Difference between revisions of "Acute cholecystitis"
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Acute cholecystitis (view source)
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = | |||
| Width = | |||
| Caption = | |||
| Micro = edema, hemorrhage, +/-neutrophils, +/-reactive epithelial changes | |||
| Subtypes = | |||
| LMDDx = [[chronic cholecystitis]], [[intestinal metaplasia of the gallbladder]], [[gallbladder dysplasia]], [[adenocarcinoma of the gallbladder]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = wall thickening (due to edema), gallstone(s) in the neck (classic finding) | |||
| Grossing = | |||
| Site = [[gallbladder]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = elderly individuals | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = wall thickening (>3 mm), gallstone(s) in the neck | |||
| Endoscopy = | |||
| Prognosis = benign, good | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''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.<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>{{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. | |||
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]]. | |||
===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>STC. 25 February 2009.</ref> | |||
==Sign out== | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- ACUTE CHOLECYSTITIS. | |||
- CHOLELITHIASIS. | |||
</pre> | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- ACUTE AND CHRONIC CHOLECYSTITIS WITH MULTIPLE MUCOSAL EROSIONS AND FOCAL NECROSIS OF THE GALLBLADDER WALL. | |||
</pre> | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- GANGRENOUS CHOLECYSTITIS. | |||
- CHOLELITHIASIS. | |||
</pre> | |||
===Micro=== | |||
The sections show gallbladder wall with hemorrhage, and activated fibroblasts. The superficial mucosa has clusters of neutrophils. | |||
==See also== | |||
*[[Chronic cholecystitis]]. | |||
*[[Gallbladder]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Gallbladder]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||