Acute cholecystitis: Pathogenesis, clinical features, and diagnosis
- Salam F Zakko, MD, FACP
Salam F Zakko, MD, FACP
- Executive Director, Connecticut Gastroenterology Institute
- Clinical Professor of Medicine, University of Connecticut School of Medicine
- Nezam H Afdhal, MD, FRCPI
Nezam H Afdhal, MD, FRCPI
- Senior Physician in Hepatology
- Beth Israel Deaconess Medical Center
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
Acute cholecystitis predominantly occurs as a complication of gallstone disease and typically develops in patients with a history of symptomatic gallstones. In a systematic review, it was seen in 6 to 11 percent of patients with symptomatic gallstones over a median follow-up of 7 to 11 years . (See "Uncomplicated gallstone disease in adults", section on 'Natural history'.)
This topic will review the pathogenesis, clinical manifestations, and diagnosis of acute cholecystitis. The management of uncomplicated gallstone disease, acalculous cholecystitis, and the treatment of acute cholecystitis are discussed separately. (See "Uncomplicated gallstone disease in adults" and "Acalculous cholecystitis" and "Treatment of acute calculous cholecystitis".)
The term cholecystitis refers to inflammation of the gallbladder. It may develop acutely in association with gallstones (acute cholecystitis) or, less often, without gallstones (acalculous cholecystitis). It may also develop over time and be discovered histologically following cholecystectomy (chronic cholecystitis).
Acute cholecystitis — Acute cholecystitis refers to a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation that is usually related to gallstone disease.
Acalculous cholecystitis — Acalculous cholecystitis is clinically identical to acute cholecystitis but is not associated with gallstones and usually occurs in critically ill patients. It accounts for approximately 10 percent of cases of acute cholecystitis and is associated with high morbidity and mortality rates . (See "Acalculous cholecystitis".)
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- Acute cholecystitis
- Acalculous cholecystitis
- Chronic cholecystitis
- CLINICAL MANIFESTATIONS
- Physical examination
- Laboratory evaluation
- Murphy's sign
- Imaging studies
- - Ultrasonography
- - Cholescintigraphy (HIDA scan)
- - Morphine cholescintigraphy
- - Magnetic resonance cholangiography
- - Computed tomography
- - Oral cholecystography
- DIFFERENTIAL DIAGNOSIS
- Cholecystoenteric fistula
- Gallstone ileus
- Emphysematous cholecystitis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS