Outline the clinical manifestations, appropriate investigations, and treatment of acalculous cholecystitis.
Clinical presentation is variable and all signs and investigations lack sensitivity and specificity. 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 (may be diagnostic) +/- CT abdomen and blood cultures. HIDA scans are reported to be useful in cases when diagnoses can’t be established with certainty.
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.
Acalculous cholecystitis receives a detailed treatment elsewhere.
- RUQ pain
- High bilirubin
- Cholestatic pattern of LFT elevation
- Sympathetic right sided pleural effusion
- Haemodynamic instability
- Abdominal ultrasound
- Abdominal CT
- Blood cultures
Laurila, Jouko, et al. "Acute acalculous cholecystitis in critically ill patients."Acta anaesthesiologica scandinavica 48.8 (2004): 986-991.
Wang, Ay-Jiun, et al. "Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis." Heart 1500 (2003): 8.
Boland, Giles W., et al. "Percutaneous cholecystostomy in critically ill patients: early response and final outcome in 82 patients." American Journal of Roentgenology 163.2 (1994): 339-342.