Acalculous cholecystitis
Reviewed and revised 5/5/12
OVERVIEW
- often complication of various conditions
- high incidence of gangrene -> perforation
- high mortality & morbidity
- pathophysiology: bile stasis + increased viscosity c/o fever, dehydration, no enteral feeding -> CCK induced gall bladder contraction with wall ischaemia
CLINICAL FEATURES
- new sepsis or shock
- variable signs
- abdominal pain
- RUQ pain
- Murphy’s sign positive
- icterus
Risk Factors
- critically ill (mechanical ventilation, sepsis, burns, trauma)
- HIV
- TPN
- pregnancy -> prolonged labour
- DM
- major surgery
- vasculitis
INVESTIGATIONS
Laboratory
- leucocytosis
- hyperbilrubinaemia
- increased ALP
- transaminitis
- positive blood cultures
Imaging
- US: distended acalculous gall bladder, thickened wall, pericholic fluid
- CT: above changes
- Hepatobillary Imino-Diacetic Acid scan (HIDA)
— nuclear imaging procedure -> Technetium-99m IV -> uptake in GB should take place in 1 hour, if not -> cholecystitis/cystic duct obstruction (used if diagnosis uncertain)
MANAGEMENT
Resuscitation
- A and B – often intubated and ventilated for primary pathology
- C – support shock with fluids and vasoactives
- early broad-spectrum antibiotic coverage: Cefuroxime + Metronidazole
Acid-Base and Electrolytes
- proportional to shock
Specific Treatment
- early surgical consultation if rapidly deteriorating and perforated
- drainage (percutaneous) – U/S or CT
- cholecystectomy
- NBM
Underlying Cause
- treat underlying illness
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC