Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Cholecystitis Differential Diagnoses

  • Author: Alan A Bloom, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Apr 15, 2016
 
 

Diagnostic ConsiderationsPregnant patients

Delay in making the diagnosis of acute cholecystitis result in a higher incidence of morbidity and mortality. This is especially true for intensive care unit (ICU) patients who may develop acalculous cholecystitis. The diagnosis should be considered and investigated promptly in order to prevent poor outcomes.

On rare occasions, acute cholecystitis may coexist with or be misdiagnosed as a cardiovascular disorder.[15]

Right upper quadrant pain in pregnancy can be related to a number of different diagnoses, including preeclampsia, appendicitis, and cholelithiasis. Pregnant patients must have a thorough examination because complications can arise quickly and can be life threatening to both the mother and the unborn child.[16]

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Alan A Bloom, MD Associate Clinical Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Gastroenterology, Veterans Affairs Hospital, Bronx

Alan A Bloom, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Clinton S Beverly, MD Clinical Assistant Professor, Department of Surgery, Mercer University School of Medicine

Clinton S Beverly, MD is a member of the following medical societies: American College of Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jack A Di Palma, MD Director, Division of Gastroenterology, Professor, Department of Internal Medicine, University of South Alabama College of Medicine

Jack A Di Palma, MD is a member of the following medical societies: American College of Gastroenterology and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Don Gladden, DO Staff Physician, Department of Emergency Medicine, Seton Medical Center Williamson

Don Gladden, DO is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Alexandre F Migala, DO Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center

Alexandre F Migala, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association, Association of Military Osteopathic Physicians and Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Rahul Sharma, MD, MBA, FACEP Medical Director and Associate Chief of Service, NYU Langone Medical Center, Tisch Hospital Emergency Department; Assistant Professor of Emergency Medicine, New York University School of Medicine

Rahul Sharma, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Peter A D Steel, MA, MBBS Attending Physician, Department of Emergency Medicine, Joan and Sanford I Weill Cornell Medical Center, New York Presbyterian Hospital

Peter A D Steel, MA, MBBS is a member of the following medical societies: American College of Emergency Physicians, British Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jeffery Wolff, DO Consulting Staff, Department of Gastroenterology, Brooke Army Medical Center; Staff Gastroenterologist, Landstuhl Regional Medical Center

Jeffery Wolff, DO, is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

References
  1. Huffman JL, Schenker S. Acute acalculous cholecystitis - a review. Clin Gastroenterol Hepatol. 2009 Sep 9. [Medline].

  2. Donovan JM. Physical and metabolic factors in gallstone pathogenesis. Gastroenterol Clin North Am. 1999 Mar. 28(1):75-97. [Medline].

  3. Sitzmann JV, Pitt HA, Steinborn PA, et al. Cholecystokinin prevents parenteral nutrition induced biliary sludge in humans. Surg Gynecol Obstet. 1990 Jan. 170(1):25-31. [Medline].

  4. Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis. Ann Surg. 2000 Aug. 232(2):202-7. [Medline].

  5. Forbes LE, Bajaj M, McGinn T, et al. Perihepatic abscess formation in diabetes: a complication of silent gallstones. Am J Gastroenterol. 1996 Apr. 91(4):786-8. [Medline].

  6. Huang J, Chang CH, Wang JL, Kuo HK, Lin JW, Shau WY, et al. Nationwide epidemiological study of severe gallstone disease in Taiwan. BMC Gastroenterol. 2009 Aug 22. 9:63. [Medline]. [Full Text].

  7. Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. 2009 Aug 3. [Medline].

  8. Tornqvist B, Waage A, Zheng Z, Ye W, Nilsson M. Severity of acute cholecystitis and risk of iatrogenic bile duct injury during cholecystectomy, a population-based case-control study. World J Surg. 2016 May. 40 (5):1060-7. [Medline].

  9. McEvoy CF, Suchy FJ. Biliary tract disease in children. Pediatr Clin North Am. 1996 Feb. 43(1):75-98. [Medline].

  10. Gruber PJ, Silverman RA, Gottesfeld S, et al. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med. 1996 Sep. 28(3):273-7. [Medline].

  11. Nidimusili AJ, Alraies MC, Eisa N, Alraiyes AH, Shaheen K. Leukocytosis of unknown origin: gangrenous cholecystitis. Case Rep Med. 2013. 2013:418014. [Medline]. [Full Text].

  12. Liolios A, Oropello JM, Benjamin E. Gastrointestinal complications in the intensive care unit. Clin Chest Med. 1999 Jun. 20(2):329-45, viii. [Medline].

  13. Chiu HH, Chen CM, Mo LR. Emphysematous cholecystitis. Am J Surg. 2004 Sep. 188(3):325-6. [Medline].

  14. Moscati RM. Cholelithiasis, cholecystitis, and pancreatitis. Emerg Med Clin North Am. 1996 Nov. 14(4):719-37. [Medline].

  15. Ozeki M, Takeda Y, Morita H, et al. Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department. BMC Res Notes. 2015 Dec 19. 8 (1):805. [Medline].

  16. Yates MR 3rd, Baron TH. Biliary tract disease in pregnancy. Clin Liver Dis. 1999. 3:131-147.

  17. Singer AJ, McCracken G, Henry MC, et al. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med. 1996 Sep. 28(3):267-72. [Medline].

  18. [Guideline] Katz DS, Rosen MP, Blake MA, et al; and Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® right upper quadrant pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2010. [Full Text].

  19. Towfigh S, McFadden DW, Cortina GR, et al. Porcelain gallbladder is not associated with gallbladder carcinoma. Am Surg. 2001 Jan. 67(1):7-10. [Medline].

  20. Stephen AE, Berger DL. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery. 2001 Jun. 129(6):699-703. [Medline].

  21. Bingener J, Schwesinger WH, Chopra S, et al. Does the correlation of acute cholecystitis on ultrasound and at surgery reflect a mirror image?. Am J Surg. 2004 Dec. 188(6):703-7.

  22. Jang T, Aubin C, Naunheim R. Minimum training for right upper quadrant ultrasonography. Am J Emerg Med. 2004 Oct. 22(6):439-43. [Medline].

  23. Roe J. Evidence-based emergency medicine. Clinical assessment of acute cholecystitis in adults. Ann Emerg Med. 2006 Jul. 48(1):101-3. [Medline].

  24. Rosen CL, Brown DF, Chang Y, et al. Ultrasonography by emergency physicians in patients with suspected cholecystitis. Am J Emerg Med. 2001 Jan. 19(1):32-6. [Medline].

  25. Rubens DJ. Hepatobiliary imaging and its pitfalls. Radiol Clin North Am. 2004 Mar. 42(2):257-78. [Medline].

  26. Shah K, Wolfe RE. Hepatobiliary ultrasound. Emerg Med Clin North Am. 2004 Aug. 22(3):661-73, viii. [Medline].

  27. Kawai R, Hata J, Manabe N, et al. Contrast-enhanced ultrasonography with Sonazoid for diagnosis of gangrenous cholecystitis. J Med Ultrason (2001). 2016 Apr. 43 (2):193-9. [Medline].

  28. Pereira J, Afonso AC, Constantino J, et al. Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. Eur J Trauma Emerg Surg. 2015 Dec 22. [Medline].

  29. Kim YK, Kwak HS, Kim CS, Han YM, Jeong TO, Kim IH, et al. CT findings of mild forms or early manifestations of acute cholecystitis. Clin Imaging. 2009 Jul-Aug. 33(4):274-80. [Medline].

  30. Wang A, Shanbhogue AK, Dunst D, Hajdu CH, Rosenkrantz AB. Utility of diffusion-weighted MRI for differentiating acute from chronic cholecystitis. J Magn Reson Imaging. 2015 Dec 22. [Medline].

  31. Sahai AV, Mauldin PD, Marsi V, et al. Bile duct stones and laparoscopic cholecystectomy: a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP. Gastrointest Endosc. 1999 Mar. 49(3 Pt 1):334-43. [Medline].

  32. Siddiqui T, MacDonald A, Chong PS, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008 Jan. 195(1):40-7. [Medline].

  33. Cox MR, Wilson TG, Luck AJ, et al. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg. 1993 Nov. 218(5):630-4. [Medline].

  34. Lo CM, Liu CL, Fan ST, et al. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998 Apr. 227(4):461-7. [Medline].

  35. Ikumoto T, Yamagishi H, Iwatate M, Sano Y, Kotaka M, Imai Y. Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis. World J Gastrointest Endosc. 2015 Dec 25. 7 (19):1327-33. [Medline].

  36. Zafar SN, Obirieze A, Adesibikan B, Cornwell EE 3rd, Fullum TM, Tran DD. Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg. 2015 Feb. 150 (2):129-36. [Medline].

  37. [Guideline] Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010 Oct. 24(10):2368-86. [Medline].

  38. Wilson E, Gurusamy K, Gluud C, Davidson BR. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010 Feb. 97(2):210-9. [Medline].

  39. Tarragun AV, Azagra JS, Lens V, Manzoni D, Fabiano P, Goergen M. Two Staged Minimally Invasive Treatment for Acute Cholecystitis in High Risk Patients. Hepatogastroenterology. 2013 May 1. 60(123):[Medline].

  40. Binenbaum SJ, Teixeira JA, Forrester GJ, Harvey EJ, Afthinos J, Kim GJ, et al. Single-incision laparoscopic cholecystectomy using a flexible endoscope. Arch Surg. 2009 Aug. 144(8):734-8. [Medline].

  41. Wu CH, Chen CC, Wang CJ, et al. Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings. Abdom Imaging. 2011 Apr. 36(2):174-8. [Medline].

  42. Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D. Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors. Surg Endosc. 2016 Feb 19. [Medline].

  43. Silberfein EJ, Zhou W, Kougias P, et al. Percutaneous cholecystostomy for acute cholecystitis in high-risk patients: experience of a surgeon-initiated interventional program. Am J Surg. 2007 Nov. 194(5):672-7. [Medline].

  44. Mutignani M, Iacopini F, Perri V, et al. Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy. 2009 Jun. 41(6):539-46. [Medline].

  45. Li M, Li N, Ji W, Quan Z, Wan X, Wu X, et al. Percutaneous Cholecystostomy Is a Definitive Treatment for Acute Cholecystitis in Elderly High-risk Patients. Am Surg. 2013 May. 79(5):524-7. [Medline].

  46. Lee SS, Park do H, Hwang CY, et al. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc. 2007 Nov. 66(5):1008-12. [Medline].

  47. Law R, Baron TH. Endoscopic ultrasound-guided biliary interventions: an update on recent developments. Curr Opin Gastroenterol. 2016 May. 32 (3):232-7. [Medline].

  48. Anderloni A, Buda A, Vieceli F, Khashab MA, Hassan C, Repici A. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc. 2016 Apr 8. [Medline].

  49. Greenwald JA, McMullen HF, Coppa GF, et al. Standardization of surgeon-controlled variables: impact on outcome in patients with acute cholecystitis. Ann Surg. 2000 Mar. 231(3):339-44. [Medline].

  50. Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013 Sep. 258(3):385-93. [Medline].

  51. Lowenfels A. Is early surgery better for acute cholecystitis? Medscape Medical News. November 6, 2013;. Available at http://www.medscape.com/viewarticle/813363. Accessed: December 2, 2013.

  52. Khasawneh MA, Shamp A, Heller S, et al. Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement. J Trauma Acute Care Surg. 2015 Jan. 78 (1):100-4. [Medline].

  53. Knab LM, Boller AM, Mahvi DM. Cholecystitis. Surg Clin North Am. 2014 Apr. 94 (2):455-70. [Medline].

  54. van Dijk AH, de Reuver PR, Tasma TN, van Dieren S, Hugh TJ, Boermeester MA. Systematic review of antibiotic treatment for acute calculous cholecystitis. Br J Surg. 2016 Mar 30. [Medline].

 
Previous
Next
 
Cholecystitis. Normal finding on hepatoiminodiacetic acid (HIDA) scan.
Cholecystitis. Abnormal finding on hepatoiminodiacetic acid (HIDA) scan.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.