Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
Acalculous cholecystitis — This accounts for less than 5% of cases of inflammation of the gallbladder. Infection primarily by Gram-negative organisms appears to be a major factor. The condition may develop following surgery and trauma. Unexplained postoperative fever is often the principal manifestation,199 and diagnosis often rests upon the clinical finding of tenderness in the right upper quadrant. Imaging procedures will occasionally demonstrate an enlarged, tense gallbladder, and blood cultures and febrile agglutinin titers may be useful. However, the absence of abnormal findings should not deter the clinician from making the diagnosis, since this condition carries a higher morbidity and mortality than the calculous variety. Recently acalculous cholecystitis has been described with increasing frequency as a complication of AIDS. 133,134 In these patients it is usually associated with infection with CMV, Cryptosporidium, or Campylobacter fetus.
Surgery
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
A 40-year-old lady attends your GP clinic with epigastric pain, vomiting and fever which started this morning after waking. She has noticed that she has a crampy pain in the right upper quadrant after eating fatty meals for the last 2 months. On examination, she is Murphy’s sign positive. What is contained within bile? (1 mark for each, max 2 marks)Name two types of gallstones based on composition. (2)What are risk factors for developing gallstones? (½ a mark for each, max 2 marks)What is Murphy’s sign? (2)What imaging would confirm the diagnosis of acute cholecystitis? (1)What initial management would you start? (1)
Intra-Abdominal Surgical Infections and Their Mimics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
While debate continues about the genesis of acalculous cholecystitis, it is likely to be an ischemic injury of the gallbladder wall that is the combination of splanchnic vascular disease and increased intraluminal pressure within the gallbladder lumen from poor bile transport. It is associated with right upper quadrant pain but no gallstones. Physical findings of rebound tenderness may be present, but most patients have altered sensorium, are on ventilatory support, and have sedation/opioids that suppress responsiveness. These patients are recognized with gallbladder distention on ultrasound examination of the right upper quadrant but without the presence of calculi. A high index of suspicion is necessary to promptly identify non-calculous cholecystitis. Either percutaneous decompression or removal of the gallbladder is necessary for management to avoid the sustained ischemia and gallbladder perforation from increased intraluminal pressure [22]. Medical management alone is not sufficient. Failure to recognize acalculous cholecystitis leads to transmural gangrenous changes and perforation into the abdomen cavity.
New insights in Coxiella burnetii infection: diagnosis and therapeutic update
Published in Expert Review of Anti-infective Therapy, 2020
Cléa Melenotte, Matthieu Million, Didier Raoult
In case of positive aCL, some imaging could be recommended to search for complications. TTE should be performed, whatever the height of the anticardiolipin levels. TOE should be performed in male, aged over 40 years, with aCL > 60 IgG phospholipid-binding unit, (GPLU) and negative or inconclusive TTE [41]. If the patient presents abdominal pain, abdominal CT scan or ultrasonography must be performed to look for alithiasic cholecystitis. In case of meningitis, magnetic resonance imaging should look for encephalitis such as intracerebral sign of vasculitis. Cytopenia should be carefully investigated, hemophagocytic should be seriously considered and bone marrow aspirate should be performed in case of hemophagocytic syndrome suspicion. As the hemophagocytic syndrome has been shown to be significantly associated with a risk of non-Hodgkin lymphoma (OR = 19.1, 95% CI [3.4–108.6], p < .001), 18F-FDG-PET/CT-scan must also be performed to detect deep hypermetabolism, such as lymphadenitis [4].
Advances in preventing adverse events during monoclonal antibody management of multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2019
Laura De Giglio, Alessandro E. Grimaldi, Federica Fubelli, Fabiana Marinelli, Carlo Pozzilli
The possible presence of ALZ-specific antibodies has been described in 0.6% of people before the second-infusion. During the clinical studies, antibodies had no clinical significance at population level. However, at the individual level the presence of neutralizing antibodies led to poor lymphocyte depletion suggesting a possible efficacy reduction. The frequency of detection of these antibodies increases at the end of the second cycle (31% of people had neutralizing antibodies and 75% had binding antibodies) suggesting that in people requiring additional ALZ cycles the problem could be clinically relevant [43]. Monitoring depletion following infusion and assessment of the neutralizing response before re-infusion may help inform the decision to retreat or to switch therapy to limit treatment failure. The ALZ cell depletion may increase the risk of acute acalculous cholecystitis. In controlled clinical studies, 0.2% of time to onset of symptoms ranged from less than 24 h to 2 months after ALZ infusion [26].
Acute acalculous cholecystitis in an infant after gastroschisis closure
Published in Baylor University Medical Center Proceedings, 2023
Irfan Shehzad, Nicholas Nelson, Niraj Vora, Hale Wills, Krista Birkemeier, Vinayak Govande
Acute acalculous cholecystitis (AAC) is defined as an acute inflammatory disease of the gallbladder in the absence of cholelithiasis. Tsakayannis et al8 estimated only 1.3 pediatric cases for every 1000 adult cases. AAC is believed to arise by two main mechanisms: ischemic injury from hypoperfusion and chemical injury from bile stasis. Moreover, concomitance and/or superimposition of infection with enteric pathogens including E. coli, Enterococcus faecalis, Klebsiella pneumonia, Pseudomonas, Proteus species, and Bacteroides9 contribute to the pathogenesis of AAC. Without immediate treatment, there may be rapid progression to perforation, gangrenous cholecystitis, or bile peritonitis.
Related Knowledge Centers
- Abdominal Pain
- Ascending Cholangitis
- Biliary Colic
- Inflammation
- Gallstone
- Gallbladder
- Pancreatitis
- Cystic Duct
- Quadrants & Regions of Abdomen
- Common Bile Duct Stone