Q: What is the definition of acute cholecystitis?
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A: Acute cholecystitis is an acute gallbladder inflammation and represents a frequent cause of right upper quadrant pain. In most cases, it occurs due to gallstone obstruction of the gallbladder neck or the cystic duct, called acute calculous cholecystitis. Occasionally it may develop without any calculous, known as acute acalculous cholecystitis, usually due to bile stasis, diminished cystic artery blood flow with gallbladder ischemia, cystic duct obstruction, and systemic infection. Acalculous cholecystitis occurs most often in critically ill patients.
Q: What are the clinical manifestations of acute cholecystitis?
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A: The clinical manifestations include right upper quadrant pain, fever, nausea, emesis, and focal tenderness overlying the gallbladder. This disease is more common in obese middle-aged women.
Q: What are the ultrasonography (US) findings in acute cholecystitis?
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A: The US findings of acute cholecystitis are the presence of cholelithiasis, usually impacted within the gallbladder neck or the cystic duct, positive sonographic Murphy sign, gallbladder wall thickening (> 3mm), sludge, pericholecystic fluid, abnormal gallbladder distension with convex walls (> 4cm in the transverse dimension and > 10 cm in the sagittal plane), and increased mural blood flow. In acute acalculous cholecystitis, there is no gallstone, but the other findings are similar to acute calculous cholecystitis.
Q: What is the sonographic Murphy sign?
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A: The sonographic Murphy sign represents localized pain, with tenderness caused by the transducer probe pressure on the gallbladder.
Q: What are the CT findings of acute cholecystitis?
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A: CT findings of acute cholecystitis include the following:
- cholelithiasis is present in most cases of acute cholecystitis; however, the gallstones may be noncalcified and isodense to bile; consequently, many of them are difficult to detect with CT;
- gallbladder wall thickening, > 3 mm;
- mural or mucosal hyperenhancement;
- pericholecystic fluid;
- gallbladder distention;
- high-density bile and sludge; a tensile gallbladder fundus sign;
- subserosal edema with liver parenchyma enhancement adjacent to the gallbladder due to reactive hyperemia termed transient hepatic attenuation difference;
- adjacent inflammatory fat stranding
Q: What are the treatment options for acute cholecystitis?
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A: The treatment of acute cholecystitis may vary. Some professionals prefer to administer broad-spectrum IV antimicrobials and do a nonemergent cholecystectomy after the acute inflammation has subsided. However, another option may be immediate surgical cholecystectomy because emergent cholecystectomy may be as safe as delayed surgical intervention. In specific situations, percutaneous catheter drainage to decrease intraluminal pressure of the gallbladder is the treatment of choice.