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Acute cholecystitis

Last reviewed: 1 Nov 2024
Last updated: 14 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • previous episode of biliary pain
  • right upper quadrant pain
  • positive Murphy sign
  • abdominal mass
Full details

Other diagnostic factors

  • right shoulder pain
  • anorexia
  • nausea
  • fever
  • vomiting
  • jaundice
Full details

Risk factors

  • gallstones
  • physical inactivity
  • low fiber intake
  • severe illness
  • trauma
  • severe burns
  • total parenteral nutrition (TPN)
  • diabetes
  • ceftriaxone
  • cyclosporine
  • hepatic arterial embolization
  • infections
Full details

Diagnostic tests

1st tests to order

  • CBC
  • C-reactive protein
  • LFTs
  • right upper quadrant ultrasound scan
Full details

Tests to consider

  • cholescintigraphy (hepatobiliary iminodiacetic acid [HIDA] scan)
  • abdominal CT
  • abdominal MRI
  • abdominal x-ray
Full details

Treatment algorithm

ACUTE

mild (grade I): stable without signs of perforation/gangrene

moderate (grade II): stable with signs of perforation/gangrene

severe (grade III): suspected gangrene/perforation or evidence of organ dysfunction

Contributors

Authors

Charles Bellows, MD

Professor of Surgery

University of New Mexico

School of Medicine

Albuquerque

NM

Disclosures

CB is an author of one study referenced in this topic. CB declares that he has no other competing interests.

Peer reviewers

Satyajit Bhattacharya, LVO, MB, MS, MPhil, FRCS

Consultant Surgeon

HPB Surgery Unit

The Royal London Hospital

London

UK

Disclosures

SB declares that he has no competing interests.

Stefano Guandalini, MD

Professor of Pediatrics

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Chicago Comer Children's Hospital

Chicago

IL

Disclosures

SG declares that he has no competing interests.

  • Acute cholecystitis images
  • Differentials

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  • Guidelines

    • ACR appropriateness criteria: right upper quadrant pain
    • TG18 flowchart for the management of acute cholecystitis
    More Guidelines
  • Patient information

    Gallstones

    More Patient information
  • Videos

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