Fast Five Quiz: Gallbladder Disease

B.S. Anand, MD


December 08, 2021

Patients with acalculous cholecystitis may present similarly to those with calculous cholecystitis, but acalculous cholecystitis frequently occurs suddenly in severely ill patients without a prior history of biliary colic. Often, patients with acalculous cholecystitis present with fever and sepsis alone, without a history or physical examination findings consistent with acute cholecystitis.

Cholelithiasis, the major risk factor for cholecystitis, has an increased prevalence in people of Scandinavian descent, Pima Indians, and Hispanic populations, whereas cholelithiasis is less common among individuals from sub-Saharan Africa and Asia. In the United States, the prevalence is higher in White individuals than in Black individuals.

Gallstones are more common in females than in males, resulting in a higher incidence of calculous cholecystitis in females. Elevated progesterone levels during pregnancy may cause biliary stasis, resulting in higher rates of gallbladder disease in pregnant females. Acalculous cholecystitis is observed more often in older men.

The physical examination may reveal fever, tachycardia, and tenderness in the right upper quadrant (RUQ) or the epigastric region, often with guarding or rebound. The Murphy sign, which is specific but not sensitive for cholecystitis, is described as tenderness and an inspiratory pause elicited during palpation of the RUQ. The absence of physical findings does not rule out the diagnosis of calculous or acalculous cholecystitis. Many patients present with diffuse epigastric pain without localization to the RUQ.

Learn more clinical information about acalculous cholecystitis.


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