Review Question - QID 204810

This patient's presentation is consistent with a diagnosis of acute cholecystitis. Elevated female sex hormones and hormonal replacement therapy are risk factors for cholecystitis.

Cholecystitis is caused by prolonged blockage of the cystic duct (typically by a lodged gallstone) that leads to distension, inflammation, and ultimately superinfection of the gallbladder. Additional risk factors include female gender, age > 40, overweight/obese, diabetic, total parental nutrition, rapid fluctuations in body weight, and Native American ancestry.
Abdominal ultrasound is the gold-standard of diagnosing cholelithiasis and cholecystitis. Cholecystitis manifests on ultrasound as visible stones, a thickened gallbladder wall, and pericholecystic fluid. Acalculous cholecystitis, cholecystitis in the absence of gallstones, is often seen in critically or chronically ill ICU patients.

Abraham et al. discusses the management of gallstones. Biliary colic, intermittent obstruction of the cystic duct, may precede the development of acute cholecystitis. The development of cholecystitis is heralded by persistent pain, fever, and elevated white blood cell count. In addition to cholecystitis, other complications of gallstones can include pancreatitis or ascending cholangitis.

Jick and Pennap examine the commonly held belief that oral contraceptives increase risk of gallbladder disease. They found that women taking drospirenone- or levonorgestrel-containing oral contraceptives do NOT have an elevated risk of gallbladder disease compared to women who are not taking any oral contraceptive. It appears that these progesterone-containing derivatives may not have an effect on gallbladder disease, whereas medications containing estrogen alone may have an association. Additional and ongoing research needs to be conducted in order to further elucidate and confirm these findings.

Figure A shows an ultrasound of acute cholecystitis; note the thickened wall and pericholecystic fluid. Illustration A summarizes risk factors for the development of cholecysitis.

Incorrect Answers:
Answer 1: Steroids, such as prednisone, do not increase the risk of developing acute cholecystitis.
Answer 2: Meperidine is the pain medication of choice in treating acute cholecystitis, as, unlike morphine, it does not increase muscle tone at the sphincter of Oddi.
Answer 3: NSAIDs, such as naproxen, have been shown to reduce the secretion of gallbladder mucin and thereby decrease the risk of developing gallstones and their ensuing complications.
Answer 5: Gallbladder disease is not a known side-effect of the antibiotic TMP-SMX.