Acalculous cholecystitis is a form of gallbladder inflammation that occurs without the presence of gallstones. It is less common than the more typical form of cholecystitis, which is usually associated with gallstones. Acalculous cholecystitis can be a serious condition and is often seen in critically ill patients.
Causes
Several factors can contribute to the development of acalculous cholecystitis:
- Biliary Stasis: Reduced movement of bile, often due to prolonged fasting, immobility, or critical illness.
- Vascular Compromise: Conditions that reduce blood flow to the gallbladder, such as hypotension or shock.
- Infections: Bacterial infections can lead to inflammation of the gallbladder.
- Trauma or Surgery: Physical trauma or recent surgical procedures can trigger inflammation.
- Underlying Conditions: Chronic diseases such as diabetes, liver disease, or malignancies may increase the risk.
Symptoms
Symptoms of acalculous cholecystitis may include:
- Abdominal Pain: Typically in the upper right quadrant, but can be diffuse.
- Nausea and Vomiting
- Fever: Often present due to inflammation or infection.
- Tenderness: Abdominal tenderness, particularly in the right upper quadrant.
- Jaundice: Yellowing of the skin and eyes can occur if the bile duct is obstructed.
Diagnosis
Diagnosis typically involves several approaches:
Medical History and Physical Examination: Assessment of symptoms and abdominal examination.
Imaging Studies:
- Ultrasound: The initial imaging modality to assess the gallbladder for thickening of the walls or fluid accumulation.
- CT Scan: Provides more detailed images and can help identify complications.
- HIDA Scan: May be used to evaluate gallbladder function and detect inflammation.
Blood Tests: To check for elevated white blood cell counts, liver enzymes, and bilirubin levels, indicating inflammation or infection.
Treatment
Treatment for acalculous cholecystitis usually involves:
Hospitalization: Patients are often hospitalized for close monitoring and management.
Supportive Care: This may include IV fluids, antibiotics, and pain management.
Surgery: If symptoms are severe or complications arise, surgical intervention may be necessary. This can involve:
- Cholecystectomy: Surgical removal of the gallbladder, which may be performed laparoscopically or as an open procedure.
- Percutaneous Drainage: In cases where surgery is not feasible, a drain may be placed to relieve pressure and allow for fluid drainage.
Complications
Acalculous cholecystitis can lead to serious complications, including:
- Perforation of the Gallbladder: This can lead to peritonitis, a life-threatening condition.
- Abscess Formation: Pockets of infection can develop.
- Sepsis: A systemic infection that can occur due to bacteria entering the bloodstream.
Prognosis
The prognosis for acalculous cholecystitis depends on early diagnosis and prompt treatment. If managed effectively, most patients can recover well, but the condition can be severe, particularly in critically ill individuals.