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Acute Cholecystitis
urgentinflammatory
Description
Acute inflammation of the gallbladder, typically caused by obstruction of the cystic duct by gallstones or biliary sludge. Without prompt treatment, complications include gangrene or perforation.
Key Features
- RUQ pain > 8 hours (distinguishes from biliary colic)
- Positive Murphy's sign
- Fever, nausea, vomiting
- Pain following food intake, often begins at night
- Leukocytosis with left shift
Diagnostic Criteria
- Tokyo Guidelines (TG18) Severity Grading:
- Grade I (Mild): Acute cholecystitis without organ dysfunction, mild inflammatory changes
- Grade II (Moderate): WBC > 18,000, palpable tender mass in RUQ, duration > 72 hours, marked local inflammation
- Grade III (Severe): Cardiovascular, neurological, respiratory, renal, hepatic, or hematological dysfunction
Red Flags
- • Charcot triad (fever, jaundice, RUQ pain) — cholangitis
- • Reynolds pentad (+ shock, mental status changes)
- • Peritoneal signs suggesting perforation
- • WBC > 18,000 suggesting gangrenous cholecystitis
Differential Clues
Pain > 8 hours distinguishes from biliary colicMurphy's sign highly specificUltrasound shows wall thickening + stones
Sources: DynaMed. Acute Cholecystitis. EBSCO Information Services. | Tokyo Guidelines 2018 (TG18)