Cholecystitis is inflammation of the gallbladder, most commonly caused by obstruction of the cystic duct by gallstones (calculous cholecystitis). It can also occur without stones (acalculous cholecystitis), especially in critically ill patients.
Types of Cholecystitis
- Acute Calculous Cholecystitis
- Most common form
- Caused by obstruction of the cystic duct by a gallstone
- Leads to gallbladder inflammation, distension, and possible infection
- Acalculous Cholecystitis
- Occurs without stones
- Usually in critically ill, postoperative, or trauma patients
- Associated with bile stasis and ischemia
- Chronic Cholecystitis
- Repeated episodes of acute inflammation
- Leads to gallbladder wall fibrosis and thickening
⚠️ Risk Factors
- Gallstones (major risk factor)
- Female sex, obesity, age > 40
- Prolonged fasting or total parenteral nutrition (for acalculous)
- Diabetes mellitus
🩺 Clinical Features
- Right upper quadrant pain: Steady, severe, may radiate to right shoulder or back
- Fever and chills
- Nausea and vomiting
- Positive Murphy’s sign (pain and arrest of inspiration on deep palpation of RUQ)
- Jaundice is less common unless there is associated bile duct obstruction
🔍 Diagnosis
- Ultrasound: Test of choice
- Gallstones
- Gallbladder wall thickening (>3 mm)
- Pericholecystic fluid
- Sonographic Murphy’s sign
- Laboratory tests:
- Leukocytosis (elevated WBC)
- Mildly elevated liver enzymes, bilirubin (if bile duct involved)
- HIDA scan: If ultrasound inconclusive; shows failure of gallbladder visualization
🩺 Complications
- Gallbladder gangrene or perforation
- Empyema (pus in gallbladder)
- Peritonitis
- Cholecystoenteric fistula and gallstone ileus
- Chronic cholecystitis
💊 Treatment
- Initial: NPO (nothing by mouth), IV fluids, analgesia, and antibiotics
- Definitive: Laparoscopic cholecystectomy, usually within 72 hours of diagnosis
- Percutaneous cholecystostomy: For critically ill or non-surgical candidates