GI-ICU Flashcards
What is Acalculous cholecystitis?
The most likely diagnosis is acalculous cholecystitis. Acalculous cholecystitis occurs in the absence of cholelithiasis in patients who are critically ill in the ICU, patients receiving total parenteral nutrition, chronically debilitated patients, and trauma or burn victims. It presents with signs and symptoms similar to acute cholecystitis such as right upper quadrant (RUQ) pain, fever, nausea, vomiting, and Murphy sign. Murphy sign is a cessation of inspiration on palpation of the RUQ. It is not simply pain with palpation of the RUQ. Labs in patients with cholecystitis show a leukocytosis with normal bilirubin levels. Ultrasound is the best screening test and may show stones, bile sludge, pericholecystic fluid, thickened gallbladder walls, or gas in the gallbladder. When ultrasound results are equivocal, a hepatobiliary iminodiacetic acid scan should be the next test to order. IV dye is taken up by the hepatocytes, and this dye is conjugated and excreted into the common bile duct. Nonvisualization of the gallbladder only suggests cystic duct obstruction due to acute cholecystitis. Treatment for cholecystitis consists of hospitalization, IV antibiotics, IV fluids, and cholecystectomy.
