Cholecystitis

Question 1

what is Cholecystitis

Answer 1

inflammation of the gallbladder that may take one of several forms

Question 2

what are types of Cholecystitis

Answer 2

Acute, chronic
acalculous
emphysematous
gangrenous

Question 3

indications of cholecystitis

Answer 3

Thickened gallbladder wall >3 mm
•Distended gallbladder lumen >4 cm
•Gallstones
•Impacted stone in Hartmann’s pouch or cystic duct
•Positive Murphy’s sign
•Increased color Doppler flow
•Pericholecystic fluid collection

Question 4

Acute cholecystitis

Answer 4

Most common cause of acute cholecystitis is gallstones.
Acute cholecystitis is caused by stones being impacted in the cystic duct or in the neck of the gallbladder (Hartmann’s pouch).

Question 5

Clinical signs of acute cholecystitis

Answer 5

Acute right upper quadrant pain
Positive Murphy’s sign
Inspiratory arrest upon palpation of gallbladder area
Fever
Leukocytosis
Increased serum bilirubin and alkaline phosphatase levels

Question 6

Complications of acute cholecystitis

Answer 6

May be serious and include empyema, emphysematous or gangrenous cholecystitis, and perforation

Question 7

treatments for cholecysitis

Answer 7

Antibiotics
Surgery  Cholecystectomy
Laparoscopic or open cholecystectomy
Complications

Question 8

what should other fluid collections be monitored for

Answer 8

signs of change or peristalsis.

Question 9

where is significant fluid collected

Answer 9

The significant fluid is collected in the antrum and the duodenum changes shape; distinct peristaltic movement is observed with real-time imaging.

Question 10

what is emphysematous cholecystitis

Answer 10

Rare complication of acute cholecystitis

Rapidly progressive and fatal in 15% of patients

Question 11

who is affected more often by emphysematous cholecystitis

Answer 11

Affects more men than women; 50% of patients are diabetic; gallstones may not be present in 30% to 50% of patients

Question 12

what is emphysematous cholecystitis associated with

Answer 12

Associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts

Question 13

a complication of emphysematous cholecystitis

Answer 13

Gangrene with associated perforation is a complication.

Question 14

what is emphysematous cholecystitis considered to be

Answer 14

This condition is a surgical emergency.

Question 15

what will sonographic appearance depend on in emphysematous cholecystitis

Answer 15

Sonographic appearance depends on the amount of gas within the wall of the gallbladder.

Question 16

if the gas is intraluminal (emphysematous cholecystitis)

Answer 16

Prominent bright echo is demonstrated along the anterior wall with a ring down or comet-tail artifact directly posterior to the echogenic structure.

Question 17

if a large amount of gas is present (emphysematous cholecystitis)

Answer 17

Appears as a “packed bag” or WES sign with a curvilinear echogenic area with complete posterior fuzzy shadowing

Question 18

what is gangrenous cholecystitis

Answer 18

Is a serious, painful complication of acute cholecystitis that may lead to perforation.

Occurs after a prolonged infection, which causes the gallbladder to undergo necrosis.

Question 19

what may the appearance of the gallbladder be (gangrenous cholecystitis)

Answer 19

Gallbladder wall may be thickened and edematous with focal areas of exudate, hemorrhage, and necrosis.
Ulcerations and perforations may be present, resulting in pericholecystic abscesses or peritonitis.
Gallstones or fine gravel occur in 80% to 95% of patients.

Question 20

what is the common echo feature of gangrenous cholecystitis

Answer 20

The common echo feature of gangrene is the presence of diffuse medium to coarse echogenic densities filling the gallbladder lumen in the absence of bile duct obstruction.

Question 21

what does the echogenic material of gangrenous cholecystitis have

Answer 21

Does not cause shadowing
Is not gravity-dependent
Does not show a layering effect

Question 22

what is acalculous cholecystitis

Answer 22

Is the acute inflammation of the gallbladder in the absence of cholelithiasis

Is most likely caused by decreased blood flow through the cystic artery

Question 23

what may precede the development of acalculous cholecystitis

Answer 23

Conditions that produce depressed motility (e.g., trauma, burns, postoperative patients, HIV, etc.) may precede the development of acalculous cholecystitis.

Question 24

what else may cause acalculous cholecystitis

Answer 24

Extrinsic compression of the cystic duct by a mass or lymphadenopathy may also cause this condition.

Question 25

Clinical finding of acalculous cholecystitis

Answer 25

Clinically, the patient has a positive Murphy’s sign.