Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-10-31T22:24:23.482Z Has data issue: false hasContentIssue false

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akyurek, M, Salman, B, Yuksel, O, et al. Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystostomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2005;15(6):315–20.CrossRefGoogle ScholarPubMed
Bornman, P C, Beljon, J I, Krige, J E J. Management of cholangitis. J Hepatobiliary Pancreat Surg 2003;10:406–14.CrossRefGoogle ScholarPubMed
Fagan, S P, Awad, S S, Rahwan, K, et al. Prognostic factors for the development of gangrenous cholecystitis. Am J Surg 2003;186:481–5.CrossRefGoogle ScholarPubMed
Gigot, J F, Leese, T, Bereme, T, et al. Acute cholangitis. Multivariate analysis of risk factors. Ann Surg 1989;209:435–8.CrossRefGoogle ScholarPubMed
Glasgow, R E, Visser, B C, Harris, H W, et al. Changing management of gallstone disease during pregnancy. Surg Endosc 1998;12:241–6.CrossRefGoogle ScholarPubMed
Gruber, P J, Silverman, R A, Gottesfeld, S, et al. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med 1996;28:273–7.CrossRefGoogle ScholarPubMed
Lai, E C, Mok, F P, Tan, E S, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992;326:1582–6.CrossRefGoogle ScholarPubMed
Lai, P B S, Kwong, K H, Leung, K L, et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 1998;85:764–7.CrossRefGoogle ScholarPubMed
Lo, C M, Liu, C I, Fan, S T, et al. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998;227:461–7.CrossRefGoogle ScholarPubMed
Lowe, S A. Diagnostic radiography in pregnancy: risks and reality. Aust N Z J Obstet Gynaecol 2004;44:191–6.CrossRefGoogle Scholar
Osman, M, Laustern, S B, El-Sefi, T, et al. Biliary parasites. Dig Surg 1998;15:287–96.CrossRefGoogle ScholarPubMed
Poon, R T, Liu, C L, Lo, C M, et al. Management of gallstone cholangitis in the era of laparoscopic cholecystectomy. Arch Surg 2001;136:11–6.CrossRefGoogle ScholarPubMed
Singer, A J, McCracken, G, Henry, M C, et al. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med 1996;28:267–72.CrossRefGoogle ScholarPubMed
Sung, J J, Lyon, D J, Suen, R, et al. Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial. J Antimicrob Chemother 1995;35:855–64.CrossRefGoogle ScholarPubMed
Yusoff, I F, Barkun, J S, Barkun, A N. Diagnosis and management of cholecystitis and cholangitis. Gastroenterol Clin North Am 2003; 32:1145–68.CrossRefGoogle ScholarPubMed
IDSA Guidelines. Clin Infect Dis 2003 October 15;37:997.CrossRef
Indar, A A, Beckingham, I J. Acute cholecystitis. BMJ 2002;325:639–43.CrossRefGoogle ScholarPubMed
Lillemoe, K D. Surgical treatment of biliary tract infections. Am Surg 2000 Feb;66(2):138–44.Google Scholar
Mazuski, J E, Sawyer, R G, Nathans, A B, et al. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: an executive summary. Surg Infect 2002;3(3).Google Scholar
Solomkin, J S, Mazuski, J E, Baron, E J, et al. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis 2003 Oct 15;37:997–1005.CrossRefGoogle Scholar
Westphal, J F, Brogard, J M. Biliary tract infections: a guide to treatment. Drugs 1999 Jan;57(1):81–91.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • 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
×

Save book to Dropbox

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 Dropbox.

  • 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
×

Save book to Google Drive

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
×