Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Chronic Acalculous Cholecystitis 311

Chronic Acalculous Cholecystitis.........................

SUSAN A. CUMMINGS, MD

history & physical

■Loose clinical syndrome; also known as dyspepsia, biliary dyskinesia,

& acalculous biliary pain

■RUQ pain associated w/ nausea in absence of peptic disease or gall-

stones

■90% of gallbladders removed w/ this syndrome show chronic

➣cholecystitis

■75–90% of gallbladders removed incidentally at autopsy or surgery

show similar changes

■30–50% of carefully chosen pts somewhat better w/ cholecystectomy

tests

Basic Blood Tests

■Usually normal

Specific Diagnostic Tests

■Hepatobiliary scintigraphy to visualize gallbladder & IV CCK to eval-

uate gallbladder ejection fraction; abnormal is <35 EF; some studies

advocate this test, others have found it of no use in predicting who

will improve w/ surgery

differential diagnosis

■Peptic ulcer disease, GERD, IBS, biliary motility abnormality

management

What to Do First

■Exclude alternative differential diagnoses

■Hepatobiliary scintigraphy

specific therapy

■Cholecystectomy

follow-up

■Clinical to determine resolution of pain

complications and prognosis

■Usual complications of surgery

■Prognosis good if pain resolves