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14 - Infectious Biliary Diseases: Cholecystitis and Cholangitis

from Part I - Systems

Published online by Cambridge University Press:  15 December 2009

By
Lan Vu  and
Hobart Harris
Edited by
Rachel L. Chin
Lan Vu
Affiliation:
University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Hobart Harris
Affiliation:
Professor of Surgery, Chief, Division of General Surgery, Vice Chair Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

ACUTE CALCULOUS CHOLECYSTITIS

Epidemiology

The prevalence of gallstones in the general population is approximately 10–15%, and is higher in people with the following risk factors: female gender, multiparity, obesity, recent pregnancy, and hemolytic diseases (e.g., sickle cell disease). Of people with gallstones, 10–20% will develop complications such as biliary colic, cholecystitis, cholangitis, or gallstone pancreatitis.

Acute calculous cholecystitis is defined by sustained obstruction of the cystic duct or neck of the gallbladder with gallstones or sludge. In contrast, biliary colic is pain secondary to transient obstruction of the gallbladder. Acute cholecystitis is primarily a localized acute inflammatory process caused by gallbladder obstruction and subsequent distension, but is clinically managed as an infection. The pathophysiologic role of bacteria cultured from bile remains unknown.

Clinical Features

Although most patients with acute cholecystitis present with right upper quadrant tenderness, few actually present with the classic triad of fever, right upper quadrant pain, and leukocytosis. The pain of acute cholecystitis may radiate to the back and the right shoulder due to secondary irritation of the diaphragm. Acute cholecystitis can be distinguished from biliary colic by constant pain in the right upper quadrant and the presence of Murphy's sign, defined as inspiration limited by pain on palpation of the right upper quadrant.

Type
Chapter
Information
Emergency Management of Infectious Diseases , pp. 65 - 72
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • Infectious Biliary Diseases: Cholecystitis and Cholangitis
    • By Lan Vu, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Hobart Harris, Professor of Surgery, Chief, Division of General Surgery, Vice Chair Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.015
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  • Infectious Biliary Diseases: Cholecystitis and Cholangitis
    • By Lan Vu, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Hobart Harris, Professor of Surgery, Chief, Division of General Surgery, Vice Chair Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.015
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Infectious Biliary Diseases: Cholecystitis and Cholangitis
    • By Lan Vu, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Hobart Harris, Professor of Surgery, Chief, Division of General Surgery, Vice Chair Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.015
Available formats
×