Cholecystitis

Major complication of cholelithiasis (i.e., gallstones); symptomatic gallstones are common before developing cholecystitis.

RUQ pain lasting more than 3 to 6 hours and fever are common.

RUQ tenderness, a distended RUQ mass, and positive Murphy sign are key examination findings.

Ultrasound is the definitive initial test; hepatobiliary iminodiacetic acid (HIDA) scanning and MRI may be helpful in cases where diagnosis is unclear.

Treatment is early cholecystectomy.

Acute cholecystitis is acute gallbladder inflammation and one of the major complications of cholelithiasis or gallstones. It develops in up to 10% of patients with symptomatic gallstones.[1]Ziessman HA. Acute cholecystitis, biliary obstruction and biliary leakage. Semin Nucl Med. 2003 Oct;33(4):279-96. http://www.ncbi.nlm.nih.gov/pubmed/14625840?tool=bestpractice.com In most cases (90%), it is caused by complete cystic duct obstruction usually due to an impacted gallstone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall.[1]Ziessman HA. Acute cholecystitis, biliary obstruction and biliary leakage. Semin Nucl Med. 2003 Oct;33(4):279-96. http://www.ncbi.nlm.nih.gov/pubmed/14625840?tool=bestpractice.com In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing an acalculous cholecystitis.[1]Ziessman HA. Acute cholecystitis, biliary obstruction and biliary leakage. Semin Nucl Med. 2003 Oct;33(4):279-96. http://www.ncbi.nlm.nih.gov/pubmed/14625840?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: The biliary treeCreated by BMJ Publishing Group [Citation ends].