acute cholecystitis is the fourth most common cause of hospital admissions for patients presenting with an acute abdomen in the us.assess for a positive sonographic murphy’s sign ( i.e., pain elicited by pressure over the sonographically located gallbladder), pericholecystic fat inflammation or fluid and hyperemia of the gallbladder wall at power doppler.
systemic diseases such as hepatic dysfunction, heart failure, or renal failure may lead to diffuse gallbladder thickening .
cholecystitis is defined as inflammation of the gallbladder, commonly because of an obstruction of the cystic duct from gallstones (cholelithiasis). most cases involve stones in the cystic duct (ie, calculous cholecystitis), with about 10% of cases representing acalculous cholecystitis.
risk factors include increasing age, female sex, certain ethnic groups, obesity or rapid weight loss, drugs, and pregnancy.
acalculous cholecystitis is related to conditions associated with biliary stasis, including debilitation, major surgery, severe trauma, sepsis, long-term total parenteral nutrition (tpn), and prolonged fasting. other causes of acalculous cholecystitis include cardiac events; sickle cell disease; salmonella infections; diabetes mellitus; and cytomegalovirus, cryptosporidiosis, or microsporidiosis infections in patients with aids.
the most common presenting symptom of acute cholecystitis is upper abdominal pain. the physical examination may reveal fever, tachycardia, and tenderness in the ruq or epigastric region, often with guarding or rebound. however, the absence of physical findings does not rule out the diagnosis of cholecystitis.