Acalculous Cholecystitis: Symptoms, Causes, Diagnosis, Treatment, and Prevention

Acalculous cholecystitis is a type of inflammation of the gallbladder . This small, pear-shaped organ stores bile, a fat-digesting liquid made by the liver.e60dc2a1-f33c-4a05-9b50-8e3e8e597629224232fe-5e56-45aa-b535-81e1f01526d9 When too much cholesterol or bilirubin (a waste product from red blood cells) gets into the bile, pebble-like deposits called gallstones can form, resulting in the inflammatory disease calculus cholecystitis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629643a1524-2e30-4451-8cf3-a03aca31ee44e60dc2a1-f33c-4a05-9b50-8e3e8e597629aa5cfaa9-3a10-49a3-adb0-967606deae31 Acalculous cholecystitis, in which the gallbladder is inflamed without the presence of gallstones, is much rarer, accounting for only 5 to 10 percent of cholecystitis cases.e60dc2a1-f33c-4a05-9b50-8e3e8e597629244b5d3b-6524-4254-bd11-e79654467ed1 It is also usually more serious — and potentially even life-threatening.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297390c065-28e2-4e39-9978-1c1e7f144628
Signs and Symptoms of Acalculous Cholecystitis Symptoms “The signs and symptoms of acalculous cholecystitis are similar to calculous cholecystitis,” says Felipe Boff Maegawa, MD , a surgeon at Emory Healthcare in Atlanta who specializes in procedures related to the liver, bile ducts, gallbladder, and pancreas. If the patient experiences sharp pain when pressed deeply in the right side of the abdomen, that is called a positive Murphy sign, which is considered a hallmark of cholecystitis. This pain may come on suddenly and radiate to the shoulder and back. It also may occur when breathing in deeply.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296dc07203-a9c2-42fc-b343-e36dd45ef509e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f3e7095-5882-466f-8595-465dd126eef3 Other symptoms include: Nausea and vomiting Fever Upper abdominal pain Food intolerances, bloating, and belching In many cases, patients with acalculous cholecystitis have been in the hospital for other significant illnesses or are recovering from major surgery. “Patients who are very sick [with acalculous cholecystitis] can also be ‘septic,’” where they have dangerously low blood pressure due to infection,” says David Diehl, MD , a gastroenterologist and clinical professor of medicine and pathology at Geisinger Commonwealth School of Medicine in Danville, Pennsylvania.
Causes and Risk Factors of Acalculous Cholecystitis Causes Although the cause of acalculous cholecystitis is not entirely known, it is associated with trauma, burns, and complications from surgery, particularly in critically ill patients or those recuperating from major operations.e60dc2a1-f33c-4a05-9b50-8e3e8e597629183cd167-2305-41a9-b3d4-325db6348ecb Some surgeries can disrupt normal blood flow to the gallbladder, causing ischemia (a reduction in blood supply). A major operation may also introduce bacteria into the bloodstream and increase the risk of a gallbladder infection. In addition, surgery can reduce the gallbladder’s ability to empty bile as it should, and this buildup can further impair blood flow, damage tissue, and aggravate inflammation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629183cd167-2305-41a9-b3d4-325db6348ecb Dr. Maegawa lists the following as factors that may raise the risk of getting acalculous cholecystitis: Major surgery Trauma Burns Sepsis caused by bacterial, fungal, viral, or parasitic infections Critical illness requiring intensive care Total parenteral nutrition (TPN), in which nutrients are provided directly into the bloodstream through an IV Prolonged fasting, which along with TPN can create a slowing of fluids in the gallbladder and negatively effect the composition of bile Immunodeficiency (in HIV and transplant patients, for example) Chronic illnesses such as diabetes , hypertension , obesity , renal (kidney) failure , and atherosclerosis
How Is Acalculous Cholecystitis Diagnosed? Diagnosis “Diagnosis is usually difficult because the critically ill patients are not able to cooperate, as they are sedated, intubated, and unconscious,” says Maegawa. The diagnostic process might involve: A clinical evaluation of a patient’s symptoms, followed by a blood test to see if there is an elevated white blood count or another indication of abnormal liver functione60dc2a1-f33c-4a05-9b50-8e3e8e59762959621619-f709-405d-9543-5cee1823b267 Imaging via ultrasound (or possibly X-ray or computed tomography scan) to see if there is a thickening of the gallbladder walls or other signs of inflammation A detailed specialized scan, such as a HIDA (hepatobiliary iminodiacetic acid) scan, to check for abnormal movements (contractions) of the gallbladder and blocked bile ductse60dc2a1-f33c-4a05-9b50-8e3e8e59762959621619-f709-405d-9543-5cee1823b267 PTC (percutaneous transhepatic cholangiography), a test that involves injecting a dye into the bile ducts so images may be more clearly viewed on X-rays ERCP (endoscopic retrograde cholangiopancreatography), which uses X-rays and a long, flexible tube (endoscope) with a light and camera at one end to provide a view of the bile ducts MRCP (magnetic resonance cholangiopancreatography), which offers detailed imaging of the liver, pancreas, gallbladder, and bile drainage area
Treatment and Medication Options for Acalculous Cholecystis Treatment There are a number of different approaches for recovering from acalculous cholecystis. Note that most treatments also involve limiting food, since digestion can slow healing. Medication Options Antibiotics: Dr. Diehl calls antibiotics “the cornerstone of therapy.” They are often administered intravenously.e60dc2a1-f33c-4a05-9b50-8e3e8e597629323f0eb0-4ef1-482a-8209-ea2414e6a5e7 Fluids and pain medications: These can ease symptoms and help with healing. Surgery and Procedures Percutaneous cholecystostomy: The insertion of a drainage tube relieves pressure and helps clear infection. Cholecystectomy: In some cases, a surgeon will remove the gallbladder. Diehl stresses that doctors typically try to avoid this because patients with acalculous cholecystitis usually also have another severe medical condition that makes surgery risky. Under normal conditions, gallbladder removal is considered a safe procedure; the body adjusts as bile simply flows directly into the small intestine from the liver.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299d068a23-e99d-439e-a96c-18ecf4edc65be60dc2a1-f33c-4a05-9b50-8e3e8e597629635d0e32-2cd2-4e90-8aa5-b55d075babf8
Prevention of Acalculous Cholecystitis Prevention To help lower the chances of developing acalculous cholecystitis, Maegawa notes the importance of a healthy, active lifestyle and the importance of closely managing any chronic conditions you may have. “Conditions such as diabetes, hypertension, atherosclerosis, obesity, and HIV can increase the risk of the development of acalculous cholecystitis in the event of critical illness,” he says. It’s worth noting that the following conditions increase the incidence of acalculous cholecystitis, so taking any possible steps to avoid them could be beneficial:e60dc2a1-f33c-4a05-9b50-8e3e8e597629892ec2ce-dc8e-4c2b-bfbc-6b9dbc9d0c11 Long periods of fasting Total parenteral nutrition Drastic weight loss
Acalculous Cholecystitis Prognosis Prognosis and Outlook Acalculous cholecystitis is considered a potentially lethal disease. The number of patients who die from it ranges from 12 to 65 percent, depending on the severity of the underlying illness and the speed of diagnosis and treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e59762982575e23-34b7-4247-8efd-60ec7a4950a5 Even those who survive have a long recovery that can take months.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dae27c89-cf6d-4bd7-8924-a134e0e9b7bc
Complications of Acalculous Cholecystitis Complications If not treated promptly, the disease can lead to: Death of gallbladder tissue (gangrenous cholecystitis): This can cause a severe infection that could spread throughout the body. Gallbladder splitting open (perforated gallbladder): This also can spread the infection within your gut or lead to a buildup of pus (abscess). Emergency surgery to remove the gallbladder is needed to treat these complications in about 2 or 3 in every 10 cases.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ad99401f-5a03-4f18-bf51-24dbe3ef8078
Research and Statistics: Who Has Calculous Cholecystitis? Research and Statistics Acalculous cholecystitis accounts for 10 percent of all cases of acute (sudden) cholecystitis and 5 to 10 percent of all cases of cholecystitis (gallbladder inflammation).e60dc2a1-f33c-4a05-9b50-8e3e8e59762908a063ad-a7ae-4ed9-a7ef-887758adee5e The disease has an incidence rate of 0.12 percent in the entire population. Eight out of 10 cases of acalculous cholecystitis are in male patients, and most of those are ages 50 and older.e60dc2a1-f33c-4a05-9b50-8e3e8e597629846ca615-2d0b-4177-aaa9-1b555889ad3a
Disparities and Inequities Disparities Research suggests that racial and ethnic minorities (especially males) and people of lower socioeconomic status may be more likely to undergo percutaneous cholecystostomy (insertion of a drainage tube) instead of cholecystectomy (removal of the gallbladder), even when cholecystectomy is the preferred treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ffa3b296-c58d-4d9d-bb20-f1b3f660af4e
Related Conditions Related Conditions Acalculous cholecystitis is often related to other medical conditions, particularly those affecting the gallbladder or those that cause systemic inflammation or decreased blood flow to the gallbladder. These conditions include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c49337a6-f45e-4150-81af-c0dc8078ca79 Systemic infections Critical illnesses Major trauma or surgery Prolonged fasting Liver diseases Diabetes Immunocompromised states Certain cancers
The Takeaway Acalculous cholecystitis is a rare and life-threatening type of gallbladder infection that does not involve the presence of gallstones. The disease can develop in patients who have other significant illnesses or are recovering from major surgery. Acalculous cholecystitis can be difficult to diagnose, but the sooner it is identified and treated, the better the odds are of survival.
Resources We Trust Mayo Clinic: CholecystitisCleveland Clinic: Cholecystitis (Gallbladder Inflammation)Cedars-Sinai: CholecystitisNational Organization for Rare Disorders: Acute CholecystitisScienceDirect: Acalculous Cholecystitis



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