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Cholecystitis, Emergency Medicine

Robert G. Buckley Reviewed 06/2017
 


Basics

Description

Cholecystitis is defined as inflammation of the gallbladder. 

Etiology

  • Acute calculous cholecystitis:

    • Owing to bile stasis secondary to prolonged obstruction by a gallstone (see “Cholel...

Diagnosis

Signs and Symptoms

History

  • Acute calculous cholecystitis:

    • Dull, aching, epigastric, or right upper quadrant (RUQ) pain

    • Radiation to tip of right scapula, acromion, or thoracic spine

    • Duration >...

Treatment

Pre-Hospital

Establish IV access for patients with vomiting or severe pain. 

Initial Stabilization/Therapy

  • IV, oxygen, cardiac monitoring until myocardial ischemic cause excluded

  • Initiate IV flu...

Follow-Up

Disposition

Admission Criteria

  • All cases of cholecystitis should be admitted for parenteral antibiotics, analgesia, fluid replacement, and cholecystectomy in 24–72 hr.

  • Unstable patients (gallbl...

Pearls and Pitfalls

  • US is the 1st-line imaging procedure.

  • Perform a radionuclide scanning (HIDA) when clinical suspicion is high with equivocal US or when acalculous cholecystitis suspected.

Additional Reading

  • Barie  PS, Eachempati  SR. Acute acalculous cholecystitis. Gastroenterol Clin North Am.  2010;39:243–357.

  • Silen  W, ed. Cholecystitis and other causes of acute pain in the right...

Codes

ICD9

  • 574.00 Calculus of gallbladder with acute cholecystitis, without mention of obstruction

  • 575.0 Acute cholecystitis

  • 575.10 Cholecystitis, unspecified

  • 574.01 Calculus of gallbladder with acute cho...

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