"Acute cholecystitis refers to acute inflammation of the gallbladder, usually due to persistent obstruction of the cystic duct by a calculus. This causes gall bladder distension with consequent ischaemia, which, along with toxic damage to the wall, can progress to gangrene and perforation. It is the most common complication of cholelithiasis and the most common cause of acute right upper quadrant pain 26."
"Cholelithiasis is the major risk factor, accounting for up to 95% of cases 14 with an incidence of approximately 10–15% of adults in Western countries 26. 1–4% of individuals with cholelithiasis develop acute cholecystitis annually, and up to 10% of people with cholelithiasis will develop acute cholecystitis at some point. Predisposing factors are:"
"Cholelithiasis is the major risk factor, accounting for up to 95% of cases 14 with an incidence of approximately 10–15% of adults in Western countries 26. 1–4% of individuals with cholelithiasis develop acute cholecystitis annually, and up to 10% of people with cholelithiasis will develop acute cholecystitis at some point. Predisposing factors are:"
"99mTc-HIDA scintigraphy"
"99mTc-HIDA scintigraphy"
"unhealthy diet (e.g. high calorie, refined carbohydrates, saturated fats and low fibre) or rapid weight loss promote gallstone formation"
"parasitic infections, e.g. Ascaris lumbricoides or liver flukes"
"Ultrasound is the recommended first line modality, and can be repeated 12-24 hours later if the diagnosis is not clear, because the findings can change rapidly. The diagnosis can frequently be made on CT; HIDA scan can assess cystic duct patentcy and is more sensitive that US 23 , and MRI excels in demonstrating choledocholithiasis 24."
"However, a large meta-analysis in 2012 23 assessing the accuracy of scintigraphy, US, CT, and MRI in diagnosing cholecystitis concluded that scintigraphy is the most sensitive modality, with a sensitivity of 96% (CI 94-97%). A specificity of 90% (CI 86-93%) of scintigraphy, however, was not statistically different to that of US or MRI 23."
"However, a large meta-analysis in 2012 23 assessing the accuracy of scintigraphy, US, CT, and MRI in diagnosing cholecystitis concluded that scintigraphy is the most sensitive modality, with a sensitivity of 96% (CI 94-97%). A specificity of 90% (CI 86-93%) of scintigraphy, however, was not statistically different to that of US or MRI 23."
"Ultrasound has been been found to be 81% sensitive and 80% specific 23. Cholecystitis can be excluded if the gallbladder is nondistended ("
Expected headings
"99mTc-HIDA scintigraphy"
"Complications"
"medications (e.g. octreotide, thiazides)"
"For women, the risk of gallbladder disease increases around 8% for each birth; multiparous women have up to 10x higher risk compared to nulliparous women 25. This is due to both cholesterol supersaturation and decreased gallbladder motility."
"Ultrasound is the recommended first line modality, and can be repeated 12-24 hours later if the diagnosis is not clear, because the findings can change rapidly. The diagnosis can frequently be made on CT; HIDA scan can assess cystic duct patentcy and is more sensitive that US 23 , and MRI excels in demonstrating choledocholithiasis 24."
"Gallbladder wall thickening is unreliable; it is best measured adjacent to the liver, but may be normal, especially if the gallbladder is collapsed. Gallbladder wall oedema is common otherwise due to hypoalbuminaemia, congestive heart failure, acute hepatitis, pancreatitis, etc., and often causes gross wall thickening."
"gangrene, perforation and late infection by enteric bacteria, (7-10 days), emphysematous cholecystitis"
"Infection may occur more rapidly in the elderly, immunocompromised and diabetics."
"echogenic pericholecystic fat, omentum and triangle of Calot"