Outline the clinical manifestations, appropriate investigations, and treatment of acalculous cholecystitis.

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College Answer

Clinical presentation is variable. Symptoms/signs include fever, leukocytosis with a left shift, abdominal pain, right upper quadrant mass, hyperbilirubinaemia, increased alkaline phosphatase and serum transaminases.
Additional investigations (assuming full blood count and liver function tests have already been performed) should include: ultrasonography (usually diagnostic), erect abdominal radiograph, and blood cultures. A radioisotope (HIDA) scan may be useful if diagnosis id still unclear and time permits.
Treatment involves broad spectrum antibiotics, though the definitive treatment is drainage. Percutaneous drainage (via ultrasound guidance) may be performed if the patient is too sick to transport, otherwise invasive techniques (laparoscopic or open) may be considered.

Discussion

This question is identical to Question 17 from the second paper of 2008.