Tuesday, January 21, 2020

Acute Acalculous Cholecystitis

ED Presentation, Evaluation, and Management
emDocs - January 20, 2020 - By Conte J - Reviewed by: Koyfman A and Long B
"Key Points
  • AAC may have a higher incidence in outpatients than hospitalized, critically ill patients. Maintain a high index of suspicion in patients who present to the ED with right upper quadrant pain even in the absence of a history of cholelithiasis.
  • Men > 60 years old with atherosclerotic cardiovascular disease are the most common outpatient population to develop AAC.
  • The sensitivity of ultrasound for acute acalculous cholecystitis is not well established. If you have a high clinical suspicion and a negative ultrasound, pursue further diagnostic imaging with HIDA scan +/- CT imaging, followed by admission for diagnostic laparoscopy if all noninvasive testing is negative.
  • Acute acalculous cholecystitis follows a more fulminant course than calculous cholecystitis. Broad spectrum antibiotics with gram-negative coverage and fluid resuscitation should be started immediately if the diagnosis is suspected, with an emergent consultation to general surgery."