obsolete biliary calculus with acute cholecystitis

Obsolete Biliary Calculus with Acute Cholecystitis

Biliary calculus, also known as gallstones, can cause a range of complications when they obstruct the cystic duct or common bile duct. One such complication is acute cholecystitis, which is inflammation of the gallbladder.

• Definition: Obsolete biliary calculus refers to an old term for gallstones that have caused acute cholecystitis.
• Causes: The key event underlying calculous AC (acute cholecystitis) is the obstruction of the cystic duct by stones or sludge, leading to increased gallbladder intraluminal pressure [3][10].
• Symptoms: Acute cholecystitis can cause pain, jaundice, and fever. If left untreated, it will eventually occur in 10-20% of patients with biliary colic [9].

Relationships

• Obsolete biliary calculus is related to gallstones that have caused acute cholecystitis.
• Acute cholecystitis is a serious condition that requires prompt medical attention.

References

[1] Most patients with gallstones are asymptomatic, but stones may temporarily obstruct the cystic duct or pass through into the common bile duct [1]. [3] The key event underlying calculous AC is the obstruction of the cystic duct by stones or sludge [3]. [9] Acute cholecystitis can cause pain, jaundice, and fever [9]. [10] The resulting increase in gallbladder intraluminal pressure leads to acute cholecystitis [10].

Common Signs and Symptoms of Obsolete Biliary Calculus with Acute Cholecystitis

Obese individuals are more likely to experience symptoms of biliary calculus, which can lead to acute cholecystitis. The following signs and symptoms may be indicative of this condition:

• Abdominal Pain: A sharp, stabbing pain in the upper right quadrant of the abdomen is a common symptom of biliary calculus with acute cholecystitis [7][11]. This pain can radiate to the shoulder or back.
• Nausea and Vomiting: Many people experience nausea and vomiting due to the intense pain and discomfort caused by biliary calculus [10].
• Fever: A fever of over 100 degrees Fahrenheit may occur in up to a third of people with acute cholecystitis, indicating an infection or inflammation [12].
• Jaundice: In some cases, jaundice (yellowing of the skin and eyes) can occur due to bile duct obstruction.
• Bloating and Gas: Some individuals may experience bloating and gas in the upper abdomen.

Less Common Symptoms

In addition to these common symptoms, some people may also experience:

• Loss of Appetite: Older adults may only experience a vague loss of appetite or sense of unwellness [12].
• Abdominal Tenderness: Local abdominal tenderness over the gallbladder (ultrasonographic Murphy sign) can be indicative of acute cholecystitis [14].

Important Note

It's essential to seek medical attention if you experience any of these symptoms, as prompt treatment can help prevent complications and improve outcomes.

Diagnostic Tests for Obsolete Biliary Calculus with Acute Cholecystitis

Obese biliary calculus, also known as gallstones, can cause acute cholecystitis when they obstruct the cystic duct. The following diagnostic tests are used to confirm the presence of obsolete biliary calculus with acute cholecystitis:

• Abdominal X-ray: A simple abdominal X-ray can be used to identify calcified gallstones (see [4]). However, this test is not always reliable and may not detect non-calcified stones.
• Ultrasound (USG): Ultrasonography is the most common test used in the emergency department for the diagnosis of biliary colic and acute cholecystitis (see [3]). It can show gallstones, a thickened gallbladder wall, and other signs of inflammation. However, ultrasound may not always detect acalculous cholecystitis.
• Computed Tomography (CT): CT scans are usually not necessary for the diagnosis of acute cholecystitis but may be used in cases where ultrasound findings are equivocal (see [5]).
• Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP): MRI/MRCP can be useful in cases where ultrasound findings are unclear or when there is suspicion of other biliary diseases (see [5]).
• Hepatobiliary Iminodiacetic Acid (HIDA) scan: A HIDA scan can be used to diagnose acute cholecystitis secondary to cystic duct obstruction. It works by injecting a radioactive tracer that accumulates in the gallbladder if it is functioning normally (see [7] and [8]).
• Cholescintigraphy with Tc-99m Iminodiacetic Acid (Tc-99m-IDA) analogs: This test can be used to diagnose various acute and chronic hepatobiliary diseases, including acute cholecystitis (see [9]).

It's worth noting that the accuracy of these tests may vary depending on the individual case. A combination of clinical evaluation and imaging studies is often necessary to confirm the diagnosis of obsolete biliary calculus with acute cholecystitis.

References:

[3] Ultrasonography is the most common test used in the emergency department for the diagnosis of biliary colic and acute cholecystitis. [4] Abdominal X-ray can be used to identify calcified gallstones. [5] CT scans are usually not necessary but may be used in cases where ultrasound findings are equivocal. [7] HIDA scan can be used to diagnose acute cholecystitis secondary to cystic duct obstruction. [8] A combination of clinical evaluation and imaging studies is often necessary to confirm the diagnosis. [9] Cholescintigraphy with Tc-99m-IDA analogs can be used to diagnose various acute and chronic hepatobiliary diseases.

Based on the provided context, it appears that there are various treatment options for acute cholecystitis, but the focus here is on drug treatment for a specific condition - obsolete biliary calculus with acute cholecystitis.

Antibiotic Therapy

According to search result [9], antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. This suggests that antibiotic therapy plays a crucial role in managing acute cholecystitis, including cases involving obsolete biliary calculus.

Duration of Antibiotic Treatment

Search result [6] indicates that in patients with severe AC (acute cholecystitis), antibiotic treatment should be further extended for 4–7 days after the source of infection is controlled. This implies that a longer duration of antibiotic therapy may be necessary to effectively manage acute cholecystitis, especially when it involves obsolete biliary calculus.

Other Medications

Search result [4] mentions anti-inflammatory medications such as ketorolac or indomethacin have been reported to be effective in relieving pain from gallbladder distention. This suggests that other medications may also be used in conjunction with antibiotic therapy to manage symptoms and alleviate discomfort.

Surgical Intervention

It's essential to note that while drug treatment is an option, surgical intervention (cholecystectomy) is often the definitive treatment for acute cholecystitis, including cases involving obsolete biliary calculus. Search result [5] states that patients with acute cholecystitis typically require hospitalization; the definitive treatment is cholecystectomy.

In summary, drug treatment for obsolete biliary calculus with acute cholecystitis may involve:

• Antibiotic therapy as a primary treatment or in conjunction with surgical intervention
• Extended duration of antibiotic treatment (4–7 days) to manage severe cases
• Use of anti-inflammatory medications to alleviate symptoms and discomfort

Please note that these findings are based on the provided context, which includes search results from various sources. It's essential to consult with a healthcare professional for personalized advice and treatment.

References:

[4] - Anti-inflammatory medications for pain relief [6] - Duration of antibiotic treatment for severe AC [9] - Antibiotic therapy in acute cholecystitis

Differential Diagnosis of Obsolete Biliary Calculus with Acute Cholecystitis

Acute cholecystitis is a condition characterized by inflammation of the gallbladder, often caused by an obstruction of the cystic duct due to a gallstone. However, there are instances where biliary calculus (gallstones) may be obsolete or no longer present, yet still cause acute cholecystitis. In such cases, differential diagnosis becomes crucial to rule out other potential causes.

Possible Causes:

• Acalculous Cholecystitis: This is a form of cholecystitis that occurs without the presence of gallstones. It can be caused by dysfunction or hypokinesis of gallbladder emptying, leading to inflammation and obstruction of the cystic duct.
• Gangrenous Cholecystitis: A severe and potentially life-threatening complication of acute cholecystitis, characterized by necrosis of the gallbladder wall. This condition can occur even in the absence of biliary calculus.
• Emphysematous Cholecystitis: A rare but serious form of acute cholecystitis, where gas forms within the gallbladder due to infection or gangrene. This condition can also occur without the presence of gallstones.

Diagnostic Considerations:

When diagnosing obsolete biliary calculus with acute cholecystitis, it is essential to consider these alternative causes and rule them out through a combination of clinical evaluation, laboratory tests, and imaging studies. Some key diagnostic features to look for include:

• Clinical Presentation: Patients may present with symptoms such as right upper quadrant abdominal pain, fever, and jaundice.
• Laboratory Tests: Elevated white blood cell count, C-reactive protein, and liver enzymes can indicate inflammation and infection.
• Imaging Studies: Ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) may show signs of gallbladder inflammation, obstruction, or gangrene.

Conclusion:

Differential diagnosis of obsolete biliary calculus with acute cholecystitis requires a thorough understanding of the potential causes and diagnostic features. By considering alternative explanations for symptoms and test results, healthcare providers can accurately diagnose and manage this condition effectively.

References:

• "Overview of gallstone disease in adults" (section on 'Natural history and disease course')
• "Emphysematous cholecystitis: diagnostic problems and differential diagnosis of gallbladder gas"
• "Treatment of biliary colic with diclofenac: a randomized, double-blind, placebo-controlled study"

Note: The provided references are for general information purposes only and may not be directly related to the specific topic of obsolete biliary calculus with acute cholecystitis.