GALLSTONES AND CHOLECYSTITIS

  • 40% of gallstones become symptomatic
  • 15-20% of symptomatic gallstones progress to acute cholecystitis
  • 60% of acute cholecystitis will subside spontaneously, but will recur
  • Acalculus cholecystitis-More common in elderly than in younger patients
  • Diet is likely  unrelated to development of gallstone disease
  • Types of pain: colicky common in early acute; constant in late acute cholecystitis (after 5-6h)
  • Fever and leukocytosis are "classic signs" of cholecystitis but may be absent in 24-38% at presentation (Ann. Emerg. Med 28:273, 267-JW)
  • Diagnosis of gallstones and/or cholecystitis
  • Ultrasound is most commonly performed--can show stones in the gallbladder and signs of acute cholecystitis, e.g. gallbladder wall thickening, pericholecystic fluid, and enlargement of the gallbladder--however, can miss stones in the cystic duct or common bile duct.
  • Endoscopic ultrasound has increased sensitivity compared to transabdominal ultrasound, but is more invasive.
  • These can be seen on MRI cholangiography (Radiol. 209:781, 1998--AFP)
  • Gallbladder u/s abnormalities are common and probably nonspecific in ICU patients (Am. J. Radiol. 174:973, 2000--JW)
  • Endoscopic retrograde cholangiopancreatography (ERCP)-Can be used to diagnose (and treat) CBD stones
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