Title: Acalculous Cholecystitis<br/>Author: Michael Winters<br/><a href='http://umem.org/profiles/faculty/141/'>[Click to email author]</a><hr/><p>
<strong><u>Acalculous Cholecystitis in the Critically Ill</u></strong></p>
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Acute acalculous cholecystitis (AAC) accounts for almost 50% of cases of acute cholecystitis in the critically ill ICU patient.</li>
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Importantly, the mortality rate for AAC can be as high as 50%.</li>
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Risk factors for AAC include:
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CHF</li>
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Cardiac arrest</li>
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DM</li>
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ESRD on hemodialysis</li>
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Postoperative</li>
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Burns</li>
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Unfortunately, the physical exam is unreliable, especially in intubated and sedated patients.</li>
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Furthermore, less than half of patients with AAC are febrile or have a leukocytosis. LFTs can also be normal in up to 20% of patients.</li>
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Ultrasound remains the most common imaging modality for diagnosis.</li>
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<strong>Take Home Point: Consider AAC in the septic critically ill patient without a source.</strong></li>
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<fieldset><legend>References</legend>
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Rezende-Neto JB, et al. Abdominal catastrophes in the intensive care unit. <em>Crit Care Clin</em> 2013; 29:1017-44.</p>
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