Cholecystitis is inflammation of the gall bladder. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... The gallbladder (or cholecyst) is a pear-shaped organ that stores bile (or gall) until the body needs it for digestion. ...

Causes & Pathology

Cholecystitis results from cholelithiasis in greater than 95% of cases (presence of choleliths, or gallstones, in the gallbladder), with choleliths most commonly blocking the cystic duct directly. This leads to to inspissation of bile, bile stasis, and secondary infection by gut organisms, predominantly E coli and Bacteroides species. A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... In medicine, gallstones are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. ... Inspissation is the process of thickening by dehydration. ... Bile (or gall) is a bitter, yellow or green alkaline fluid secreted by hepatocytes from the liver of most vertebrates. ... The term stasis has several meanings: A state of stabilty, in which all forces are equal and opposing, therefore they cancel out each other. ...

The Gallbladder's wall becomes inflamed. Extreme cases may result in necrosis and rupture. Inflammation often spreads to its outer covering, thus irritating surrounding structures such as the diaphragm and bowel.

Less commonly, in debilitated and trauma patients, the gallbladder may become inflamed and infected in the absence of cholelithiasis, and is known as acute acalculous cholecystitis.

Stones in the gallbladder may not cause obstruction and the accompanying acute attack. The patient might develop a chronic, low-level inflammation which leads to a chronic cholecystitis, where the gallbladder is fibrotic and calcified.

Symptoms

Cholecystitis usually presents as a pain in the right upper quadrant. This is usually a constant, severe pain. The pain may be felt to 'refer' to the right flank or right scapular region at first. Left scapula - front view () Left scapula - rear view () In anatomy, the scapula, or shoulder blade, is the bone that connects the humerus (arm bone) with the clavicle (collar bone). ...

This is usually accompanied by a low grade fever, vomiting and nausea.

More severe symptoms such as high fever, shock and jaundice indicate the development of complications such as abscess formation, perforation or ascending cholangitis. Another complication, gallstone ileus, occurs if the gallbladder perforates and forms a fistula with the nearby small bowel, leading to symptoms of intestinal obstruction. Shock is a serious medical condition where the tissue perfusion is insufficient to meet the required supply of oxygen and nutrients. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (a clear covering over the sclera, or whites of the eyes) and mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in red blooded animals). ... Cholangitis redirects here. ... Ileus refers to loss of intestinal peristalsis. ... In medicine, a fistula (pl. ... Bowel obstruction is mechanical blockage of the intestines, preventing the normal transit of the products of digestion. ...

Chronic cholecystitis manifests with non-specific symptoms such as nausea, vague abdominal pain, belching, diarrhea

Diagnosis

Cholecystitis is usually diagnosed by a history of the above symptoms, as well examination findings:

• fever (usually low grade in uncomplicated cases)
• tender right upper quadrant +/- Murphy's sign

Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes. Categories: Possible copyright violations ...

Differential Diagnosis

Acute Cholecystitis

• This should be suspected whenever there is acute right upper quadrant or epigastric pain.
  • Other possible causes include:
    • Perforated peptic ulcer
    • Acute peptic ulcer exacerbation
    • Amoebic liver abscess
    • Acute amoebic liver colitis
    • Acute pancreatitis
    • Acute intestinal obstruction
    • Renal colic
    • Acute retrocolic appendicitis

Chronic Cholecystitis

• The symptoms of chronic cholecystitis are non-specific, thus chronic cholecystitis may be mistaken for other common disorders:
  • Peptic ulcer
  • Hiatus hernia
  • Colitis
  • Functional bowel syndrome

Investigations

Blood

Laboratory values may be notable for an elevated alkaline phosphatase, possibly an elevated bilirubin (although this may indicate choledocholithiasis), and possibly an elevation of the WBC count. CRP (C-reactive protein) is often elevated. The degree of elevation of these laboratory values may depend on the degree of inflammation of the gallbladder. Patients with acute cholecystitis are much more likely to manifest abnormal laboratory values, while in chronic cholecystitis the laboratory values are frequently normal. Ball and stick model of alkaline phosphatase Alkaline phosphatase (ALP) (EC 3. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ... Choledocholithiasis is the presence of a gallstone in the common bile duct. ...

Radiology

Sonography is a sensitive and specific modality for diagnosis of acute cholecystitis; adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%, respectively. The 2 major diagnostic criteria are cholelithiasis and sonographic Murphy's sign. Minor criteria include gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation. For other uses, see Ultrasound (disambiguation). ... This article does not cite any references or sources. ... Categories: Possible copyright violations ...

The reported sensitivity and specificity of CT scan findings are in the range of 90-95%. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and calculi outside the lumen of the gallbladder. CT cannot see noncalcified gallbladder calculi, and cannot assess for a Murphy's sign. CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... A calculus is a stone (a concretion of material, usually mineral salts) that forms in an organ or duct of the body. ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band...

Hepatobiliary scintigraphy with technetium-99m DISIDA (bilirubin) analog is also sensitive and accurate for diagnosis of chronic and acute cholecystitis. It can also assess the ability of the gall bladder to expel bile (gall bladder ejection fraction), and low gall bladder ejection fraction has been linked to chronic cholecystitis. However, since most patients with right upper quadrant pain do not have cholecystitis, primary evaluation is usually accomplished with a modality that can diagnose other causes, as well. Shown above is the bone scintigraphy of a young woman. ... General Name, Symbol, Number technetium, Tc, 43 Chemical series transition metals Group, Period, Block 7, 5, d Appearance silvery gray metal Standard atomic weight [98](0) g·mol−1 Electron configuration [Kr] 4d5 5s2 Electrons per shell 2, 8, 18, 13, 2 Physical properties Phase solid Density (near r. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ...

Therapy

X-Ray during laparoscopic cholecystectomy

For most patients, in most centres, the definitive treatment is surgical removal of the gallbladder. Supportive measures are instituted in the meantime and to prepare the patient for surgery. These measures include fluid resuscitation and antibiotics. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole. Image File history File links Download high resolution version (800x696, 67 KB) Summary X-ray of some of my organs during a laprasopic cholecystectomy. ... Image File history File links Download high resolution version (800x696, 67 KB) Summary X-ray of some of my organs during a laprasopic cholecystectomy. ... Staphylococcus aureus - Antibiotics test plate. ... The cephalosporins, are a class of β-lactam antibiotics. ... Ceftriaxone (INN) (IPA: ) is a third-generation cephalosporin antibiotic. ... An anaerobic organism or anaerobe is any organism that does not require oxygen. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ...

Gallbladder removal, cholecystectomy, can be accomplished via open surgery or a laparoscopic procedure. Laparoscopic procedures can have less morbidity and a shorter recovery stay. Open procedures are usually done if complications have developed or the patient has had prior surgery to the area, making laparoscopic surgery technically difficult. A laparoscopic procedure may also be 'converted' to an open procedure during the operation if the surgeon feels that further attempts at laparoscopic removal might harm the patient. Open procedure may also be done if the surgeon does not know how to perform a laparoscopic cholesystectomy. Laparoscopic Cholecystectomy as seen through laparoscope X-Ray during Laparoscopic Cholecystectomy Cholecystectomy (, plural: cholecystectomies,) is the surgical removal of the gallbladder. ... Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the...

In cases of severe inflammation, shock, or if the patient has higher risk for general anesthesia (required for cholecystectomy), the managing physician may elect to have an interventional radiologist insert a percutaneous drainage catheter into the gallbladder ('percutaneous cholecystostomy tube') and treat the patient with antibiotics until the acute inflammation resolves. The patient may later warrant cholecystectomy if their condition improves. Laparoscopic Cholecystectomy as seen through laparoscope X-Ray during Laparoscopic Cholecystectomy Cholecystectomy (, plural: cholecystectomies,) is the surgical removal of the gallbladder. ... Interventional Radiology (abbreviated IR or sometimes IVR) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Laparoscopic Cholecystectomy as seen through laparoscope X-Ray during Laparoscopic Cholecystectomy Cholecystectomy (, plural: cholecystectomies,) is the surgical removal of the gallbladder. ...

Complications of cholecystitis

• Perforation or rupture
• Ascending cholangitis

Cholangitis redirects here. ...

Complications of cholecystectomy

• bile leak ("biloma")
• bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic surgeries have essentially equal injuries, but the recent trend is towards fewer injuries with laparoscopy, probably because the open cases often result because the gallbladder is too difficult or risky to remove with laparoscopy)
• abscess
• wound infection
• bleeding (liver surface and cystic artery most common sites)
• hernia
• organ injury (intestine and liver at highest risk, especially if gallbladder through inflammation has become adherent/scarred to other organs (e.g. transverse colon)
• deep vein thrombosis/pulmonary embolism (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)

In anatomy of the digestive system, the colon is the part of the intestine from the cecum to the rectum. ... This article is about Deep-vein thrombosis. ...

Gall bladder perforation

Gall bladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. The early diagnosis and treatment of GBP are crucial to patient morbidity and mortality.

Approaches to this complication will vary based on the condition of an individual patient, the evaluation of the treating surgeon or physician, and the facilities' capability. It can happen at the neck from pressure necrosis of an impacted calculus, or at the fundus. It can result in a local abscess, or perforation into the general peritoneal cavity; if the bile, is infected diffuse peritonitis supervenes readily and rapidly. Death can result. For other uses, see Calculus (disambiguation). ... For the death metal band, see Abscess (band). ...

A retrospective study looked at 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis. Patients were treated with analgesics and antibiotics within the first 36 hours after admission (with a mean of 9 hours), and proceeded to surgery for a cholecystectomy. Two patients died and 6 patients had further complications. The morbidity and mortality rates were 37.5% and 12.5%, respectively in the present study. The authors of this study suggests that early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance.^[1] Laparoscopic Cholecystectomy as seen through laparoscope X-Ray during Laparoscopic Cholecystectomy Cholecystectomy (, plural: cholecystectomies,) is the surgical removal of the gallbladder. ...

See also

• Boas' sign

Boas or Boass sign is hyperaesthesia (increased or altered sensitivity) below the right scapula can be a symptom in acute cholecystitis (inflammation of the gallbladder) [1] It is one of many symptoms a medical provider may look for during an Abdominal examination[2] Additionally, it is a right subscapular...

References

1. ^ Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E (2006). "Diagnosis and treatment of gallbladder perforation". World J. Gastroenterol. 12 (48): 7832-6. PMID 17203529. 

• Shea, JA, Berlin, JA, Escarce, JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154:2573.
• Fink-Bennett, D, Freitas, JE, Ripley, SD, Bree, RL. The sensitivity of hepatobiliary imaging and real time ultrasonography in the detection of acute cholecystitis. Arch Surg 1985; 120:904.