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Emphysematous Cholecystitis

Signs & Symptoms

 Prolonged biliary pain
Ref: Harrison [ 2426]
Radiate to scapular
Ref: Cecil [ 472]
Prolonged right upper quadrant pain
Note: more than four to six hours
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults] Cecil [ 472]
Radiate to right lumbar
Ref: Cecil [ 472]

Physical Examination

 Prolonged right upper quadrant pain
Note: more than four to six hours
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults] Cecil [ 472]
Acute onset of upper abdominal pain
Ref: Cecil [ 472]
Murphys sign
Note: localized tenderness over the gallbladder
Ref: Uptodate [ Pathogenesis, clinical features, and diagnosis of acute cholecystitis] Harrison [ 279] Cecil [ 472]

Lab / Serology

 Leukocytosis
Note: 10,000–15,000 cells per microliter, >20,000/μL
Ref: Uptodate [ Pathogenesis, clinical features, and diagnosis of acute cholecystitis] Harrison [ 2427] UMLS [ C0149520]
Mild Elevated bilirubin
Note: <85.5 μmol/L [5 mg/dL], should raise concerns about complicating conditions such as cholangitis, choledocholithiasis, or the Mirizzi syndrome, much more common in acalculous than calculous cholecystitis
Ref: Uptodate [ Pathogenesis, clinical features, and diagnosis of acute cholecystitis] Harrison [ 2427]
Elevated bilirubin
Note: <85.5 μmol/L [5 mg/dL], should raise concerns about complicating conditions such as cholangitis, choledocholithiasis, or the Mirizzi syndrome, much more common in acalculous than calculous cholecystitis
Ref: Uptodate [ Pathogenesis, clinical features, and diagnosis of acute cholecystitis] Harrison [ 2427]

Imagin Study

 Calculi
Ref: Harrison [ 2427] Cecil [ 472] Unknown [ 0]
Thickened gallbladder wall
Ref: Harrison [ 2427] Cecil [ 472]
thickened gallbladder wall
Ref: Harrison [ 2427] Cecil [ 472]

Complication

 Prostration
Ref: Harrison [ 2428]
Relieved by sitting up
Ref: Uptodate [ History and physical examination in adults with abdominal pain]
Mirizzi syndrome
Note: profound jaundice resulting from extrinsic compression of the bile duct by an impacted stone in the cystic duct at the gallbladder neck
Ref: Harrison [ 2427] Harrison [ 472]

Risk Factors

 Male
Ref: Unknown [ 0]
Total parenteral nutrition
Ref: Epocrates [ https://online.epocrates.com/diseases/7832/Acute-cholecystitis/Risk-Factors]
Fifth to seventh decade
Ref: Unknown [ 0]

Cause

 gallstone
Ref: Uptodate [ Pathogenesis, clinical features, and diagnosis of acute cholecystitis] Cecil [ 474] UMLS [ C0149520]
Caused by gallstone
Ref: Uptodate [ Pathogenesis, clinical features, and diagnosis of acute cholecystitis] Cecil [ 474] UMLS [ C0149520]

Other