KEY FACTS
Terminology
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Acute inflammation of gallbladder (GB) secondary to calculus obstructing cystic duct
Imaging
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US 1st-line imaging test
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Distended GB (> 5 cm transverse diameter) with rounded/ballooned shape
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Gallstones ± impaction in GB neck or cystic duct
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Diffuse GB wall thickening (> 4-5 mm)
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Hazy delineation of GB wall with echogenic pericholecystic fat ± pericholecystic fluid
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Positive sonographic Murphy sign: Pain and tenderness with transducer pressure directly over GB
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Combination of gallstones, wall thickening, and positive Murphy sign increase specificity
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Murphy sign may be negative after opioids or when gangrenous
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Gangrenous cholecystitis : Asymmetric wall thickening, marked wall irregularities, intraluminal membranes
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Gallbladder perforation : Defect in GB wall with pericholecystic abscess or extraluminal stones
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Emphysematous cholecystitis : Gas in GB wall/lumen
Top Differential Diagnoses
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Secondary GB wall thickening or adjacent inflammatory disease
Clinical Issues
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Typically > 25 years; M:F = 1:3
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Acute right upper quadrant pain, nausea, anorexia, vomiting, local tenderness to palpation
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Increased WBC; mild elevation in liver enzymes
Scanning Tips
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Move patient to look for impacted stone in neck/cystic duct, assess Murphy sign and surrounding area