Yamamoto Satoshi, Inui Kazuo, Katano Yoshiaki, Miyoshi Hironao, Kobayashi Takashi, Matsuura Hironao
Tando, 33(1) 147-155, 2019
<p>Acute cholecystitis, i.e. acute inflammation of the gallbladder, is caused by gallstones in 85% to 95% of cases. The first stage in the course is edematous (stasis and dilation of lympatics). The next is necrotizing (hemorrhagic necrosis). The last is suppurative (abscess formation). Diagnosis is based on clinical, laboratory, and imaging findings. Physical signs include Murphy's sign and right upper quadrant abdominal mass, pain, or tenderness. Laboratory abnormalities include nonspecific inflammatory markers such as leukocytosis and elevated C-reactive protein; hepatic enzymes and bilirubin may be mildly elevated. Possible sonographic findings are gallbladder enlargement, wall thickening, stone impaction, echogenic debris, sonographic Murphy's sign, fluid surrounding the gallbladder, intramural hypoechoic layer, and hypoechoic areas showing various irregular structures and Doppler signals. Contrast computed tomography is useful when diagnosis is difficult and when pericholecystic abscess or gallbladder perforation is suspected.</p>