Acute on chronic calculous cholecystitis

Case contributed by Varun Babu , 13 Sep 2017
Diagnosis certain
Changed by Matt A. Morgan, 17 Sep 2017

Updates to Case Attributes

Presentation was changed:
On and offIntermittent upper abdominal pain
Body was changed:

Recurrent inflammation of the gall bladdergallbladder secondary to chronic stone disease and stasis is bound to havepresent with multiple on and off episodes ofintermittent flare ups. ItCholecystitis can result in complications like subsegmental portal vein thrombosis. Long standing inflammation is also a precursor for gall bladdergallbladder neoplastic transformation and needs to be treated. 

  • -<p>Recurrent inflammation of the gall bladder secondary to chronic stone disease and stasis is bound to have multiple on and off episodes of flare ups. It can result in complications like subsegmental portal vein thrombosis. Long standing inflammation is also a precursor for gall bladder neoplastic transformation and needs to be treated. </p>
  • +<p>Recurrent inflammation of the gallbladder secondary to chronic stone disease and stasis is bound to present with multiple intermittent flare ups. Cholecystitis can result in complications like subsegmental portal vein thrombosis. Long standing inflammation is also a precursor for gallbladder neoplastic transformation and needs to be treated. </p>

Updates to Study Attributes

Findings was changed:

Diffusely thickened gall bladdergallbladder wall with mild pericholecystic free fluid. Crumpled submucosalSubmucosal hyperenhancement. Multiple approximately 3mm3 mm sized radiodensecalcified calculi seen. A larger rounded calculus with peripheral egg shell calcification is seen in the neck of gall bladder. A thickened fold is seen in the fundal region. There is secondary altered perfusion in segment IV of liver with areas of suspicious subsegmental filling defects in portal venous branches - possibly chronic portal venous thrombosis. 

Updates to Quizquestion Attributes

Question was changed:
Are all gall stonesgallstones visible on CT?
Answer was changed:
No. Only radiodense gall stones are seen on CT. Ultrasound is more sensitive and specific for stone detection, especially in the hands of an experienced user.

Updates to Quizquestion Attributes

Question was changed:
In all cases of gall stonesgallstones, what else should we look for?
Answer was changed:
Apart from inflammation of the gall bladdergallbladder (cholecystitis), always looks out for stones that drop down into cystic duct, and/or common bile duct and could cause secondary upstream biliary tract dilatation.

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