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Acalculous Cholecystitis

Disease Details

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Description: Acalculous cholecystitis is an inflammation of the gallbladder without the presence of gallstones, often associated with critical illness, trauma, or systemic infection.
Type: Acalculous cholecystitis is not typically a disease with a genetic basis. It is an inflammatory condition of the gallbladder without the presence of gallstones, often occurring due to other factors such as trauma, infection, or systemic illness. Consequently, there is no specific type of genetic transmission associated with this condition.
Signs And Symptoms: Most people with gallstones do not have symptoms. However, when a gallstone temporarily lodges in the cystic duct, they experience biliary colic. Biliary colic is abdominal pain in the right upper quadrant or epigastric region. It is episodic, occurring after eating greasy or fatty foods, and leads to nausea and/or vomiting. People with cholecystitis most commonly have symptoms of biliary colic before developing cholecystitis. The pain becomes severe and constant in cholecystitis. Nausea is common and vomiting occurs in 75% of people with cholecystitis. In addition to abdominal pain, right shoulder pain can be present.On physical examination, an inflamed gallbladder is almost always tender to the touch and palpable (~25-50% of cases) in the midclavicular right lower rib margin. Additionally, a fever is common. A gallbladder with cholecystitis is almost always tender to touch. Because of the inflammation, its size can be felt from the outside of the body in 25–50% of people with cholecystitis. Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes severe pain (Murphy's sign). Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness.
Prognosis: Acalculous cholecystitis, which is inflammation of the gallbladder without gallstones, typically has a more severe prognosis than calculous cholecystitis. Patients often present with more acute and serious symptoms, and it is more common in critically ill or hospitalized patients. Early diagnosis and treatment are crucial to reducing the risk of complications such as gallbladder gangrene, perforation, or sepsis. Mortality rates can be higher, especially in the presence of comorbid conditions. Timely medical intervention, including antibiotics and often surgical removal of the gallbladder, can improve outcomes.
Onset: Acalculous cholecystitis typically has a sudden onset, often presenting with acute abdominal pain. It can develop rapidly in critically ill patients or those with significant underlying conditions. The inflammation of the gallbladder occurs without the presence of gallstones.
Prevalence: The prevalence of acalculous cholecystitis is considerably lower compared to calculous cholecystitis. It accounts for about 5-10% of all cases of acute cholecystitis.
Epidemiology: Cholecystitis accounts for 3–10% of cases of abdominal pain worldwide. Cholecystitis caused an estimated 651,829 emergency department visits and 389,180 hospital admissions in the US in 2012. The 2012 US mortality rate was 0.7 per 100,000 people. The frequency of cholecystitis is highest in people age 50–69 years old.
Intractability: Acalculous cholecystitis can be severe and challenging to manage, especially in critically ill patients. However, it is not generally considered intractable. Treatment typically involves supportive care, antibiotics, and often cholecystectomy (surgical removal of the gallbladder). Early diagnosis and appropriate intervention are crucial for effective management and to prevent complications.
Disease Severity: Acalculous cholecystitis is an inflammation of the gallbladder without the presence of gallstones. Disease severity can vary widely:

1. **Mild:** Symptoms may include upper right abdominal pain, fever, and nausea. In this stage, the condition can often be managed with antibiotics and supportive care.

2. **Moderate to Severe:** More intense symptoms such as severe abdominal pain, significant fever, jaundice, and signs of sepsis may be present. This often requires more aggressive treatments, which can include intravenous antibiotics, gallbladder drainage, or even surgery.

3. **Critical:** Acute cases can lead to complications like gallbladder gangrene, perforation, or widespread infection (sepsis), which are life-threatening and require immediate medical intervention.

Timely diagnosis and treatment are crucial to prevent severe complications.
Healthcare Professionals: Disease Ontology ID - DOID:2828
Pathophysiology: Acalculous cholecystitis is the inflammation of the gallbladder without the presence of gallstones. The pathophysiology involves several factors:

1. **Ischemia:** Reduced blood flow to the gallbladder, often due to conditions like sepsis, trauma, or extensive surgery, leads to tissue damage.
2. **Bile Stasis:** Prolonged fasting, total parenteral nutrition (TPN), or critical illness can cause the bile to become static, leading to a buildup of inflammatory mediators.
3. **Infection:** Secondary bacterial infection can occur, contributing to inflammation.
4. **Increased intraluminal pressure and distension:** This can further compromise blood flow and lead to gallbladder wall inflammation and necrosis.

These factors result in inflammation, edema, and possible necrosis of the gallbladder wall, creating a clinical condition similar to gallstone-induced cholecystitis but without stone formation.
Carrier Status: Carrier status does not apply to acalculous cholecystitis. Acalculous cholecystitis is an inflammation of the gallbladder without the presence of gallstones. It is typically associated with critical illness, trauma, or severe infections, rather than genetic or hereditary factors.
Mechanism: Blockage of the cystic duct by a gallstone causes a buildup of bile in the gallbladder and increased pressure within the gallbladder. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation and swelling of the gallbladder. Inflammation and swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, which can lead to cell death due to inadequate oxygen.
Treatment: Acalculous cholecystitis is an inflammation of the gallbladder without the presence of gallstones. Treatment typically includes:

1. **Hospitalization**: Patients usually require hospital admission.
2. **Antibiotics**: Broad-spectrum antibiotics are administered to treat any underlying infection.
3. **Percutaneous cholecystostomy**: This procedure involves drainage of the gallbladder, often performed in critically ill patients who are not surgical candidates.
4. **Cholecystectomy**: Surgical removal of the gallbladder may be necessary once the patient is stable.

Monitoring and supportive care are also crucial during treatment.
Compassionate Use Treatment: Compassionate use and off-label or experimental treatments for acalculous cholecystitis typically depend on the severity and the specific case of the patient. Traditional treatments include medical management with antibiotics and supportive care. Here are some potential off-label or experimental approaches:

1. **Antibiotics**: In severe cases, potent broad-spectrum antibiotics, sometimes used off-label, might be administered to target potential underlying infections.

2. **Percutaneous Cholecystostomy**: This is a minimally invasive procedure to drain the gallbladder, which is sometimes used in critically ill patients who may not be candidates for surgery.

3. **ERCP (Endoscopic Retrograde Cholangiopancreatography)**: Although primarily used to treat bile duct stones, in some experimental settings, ERCP might be used to relieve biliary obstruction in acalculous cholecystitis.

4. **Cholecystectomy**: While not experimental, surgery to remove the gallbladder can be considered in severe cases, even though it may be seen as aggressive for certain patient populations.

These options should be considered and discussed with healthcare professionals based on individual patient conditions, severity, and overall health.
Lifestyle Recommendations: For acalculous cholecystitis, which is inflammation of the gallbladder without gallstones, lifestyle recommendations may include:

1. **Dietary Modifications**:
- Consume a low-fat diet to reduce the strain on the gallbladder.
- Avoid high-cholesterol foods and greasy or fried foods.
- Increase intake of fruits, vegetables, and whole grains.
- Stay hydrated by drinking plenty of water.

2. **Health Management**:
- Maintain a healthy weight; obesity can increase the risk of gallbladder disease.
- Exercise regularly to promote overall digestive health.
- Manage underlying conditions such as diabetes, liver disease, or infection.

3. **Avoiding Certain Substances**:
- Limit or avoid alcohol consumption.
- Avoid smoking, which can impair digestive health.

4. **Regular Medical Follow-Up**:
- Keep up with regular check-ups, especially if you have risk factors like previous abdominal surgery, critical illness, or prolonged fasting.
- Monitor and manage any signs of infection or other medical conditions that may affect gallbladder health.

These lifestyle changes can help reduce the risk of further gallbladder issues and support overall digestive health.
Medication: For acalculous cholecystitis, the primary treatment approach generally involves supportive care such as fluid resuscitation and pain management. Additionally, broad-spectrum antibiotics targeting gram-negative enteric organisms and anaerobes are often used. Common antibiotics include:

- Piperacillin-tazobactam
- Ceftriaxone or Cefotaxime with Metronidazole
- Ciprofloxacin or Levofloxacin with Metronidazole

Please consult a healthcare professional for personalized medical advice.
Repurposable Drugs: Acalculous cholecystitis is an inflammation of the gallbladder without the presence of gallstones. Though its primary treatment often involves supportive care and potentially surgical intervention, certain drugs can be repurposed for managing symptoms and associated infection or inflammation. These include broad-spectrum antibiotics such as piperacillin-tazobactam or meropenem to address bacterial infections, and anti-inflammatory medications like ketorolac for pain control. However, the choice of therapy should be tailored to the patient's condition and underlying health issues.
Metabolites: Acalculous cholecystitis is an inflammation of the gallbladder without the presence of gallstones. Metabolites are substances produced during metabolism. There is no specific focus on particular metabolites in the pathophysiology or diagnosis of acalculous cholecystitis. However, certain inflammatory markers and bile constituents might be altered due to the infection or inflammation.
Nutraceuticals: Nutraceuticals are not standard or primary treatments for acalculous cholecystitis. This condition typically requires medical intervention, which may include antibiotics and potentially surgical procedures such as cholecystectomy. Nutraceuticals might be discussed as supplementary options for overall gallbladder health, but their effectiveness for acalculous cholecystitis specifically is not well-documented. Always consult a healthcare provider for appropriate diagnosis and treatment options.
Peptides: Peptides are short chains of amino acids that can have various biological functions, including antimicrobial activity, immunomodulation, and the ability to influence inflammation. For acalculous cholecystitis, which is an inflammation of the gallbladder without the presence of gallstones, the role of peptides in treatment or diagnosis is not well-established and remains an area of potential research.

Nanotechnology, particularly nanoparticles, may offer future therapeutic and diagnostic solutions. Potential applications could involve targeted drug delivery systems that reduce inflammation or facilitate imaging techniques for better diagnosis. However, these applications are still largely experimental and not part of standard clinical practice for managing acalculous cholecystitis.