Acalculus cholecystitis (AAC) is a disease that often goes unnoticed. This is due to ischemia of gallbladder stasis and with an estimated incidence of 1.5%. It is common in patients with sepsis or in patients after abdominal sepsis. It is diagnosed more often in intensive care and the diagnosis is often due to the severity of the underlying disease delayed.
Causes are varied and often Acalculus cholecystitis patients are sick and performed in the ICU. They can be:
1. Heart Causes
2. Abdominal aortic aneurysm from 0.7 to 0.9%
3. Coronary bypass valve heart disease, after Grafting.12%
4. Heart failure
5. Trauma and burns
6. Diabetes mellitus, visceral vasculitis
7. Embolization of cholesterol-and of the cystic artery
8. Resuscitation of hemorrhagic shock or cardiac arrest
9. Malignancies such as leukemia
10. Hile metastases
11. PTBD (percutaneous biliary drainage trans-hepatic procedures)
12. bone marrow transplant (BMT) 4%
13. secondary infection of the gallbladder
14. obstructive biliary
The pathophysiology of cholecystitis includes Acalculus
1.Bile stasis by dehydration, which carries bile thicker.
Mucosal damage in the second wall of the gallbladder.
Lysophosphatidylcholine third is an agent of bile, which is directly responsible.
Ischemia gallbladder is central to the pathogenesis of CAA. A correlation between ischemia and the asset has been suggested that hypothermic perfusion of the gallbladder, which is the fundamental assumption that the lesion leading to failure of the gall bladder microcirculation AAC cellular hypoxia leads to cell death.
Jaundice can be caused by Acalculus cholecystitis, usually caused by sepsis associated with cholestasis or rarely by extrinsic compression of the bile duct stones.
AAC is 50% to 70% of cases of acute cholecystitis in infants and older children. Dehydration is a common trigger factor, such as acute bacterial infections and viral diseases like hepatitis and upper respiratory infections. Portal node with cystic duct obstruction adenitis may be extrinsic etiologic viral infections. Recent reports suggest that the pathogenesis may be similar in adults
Abdominal ultrasound is useful in the diagnosis and ultrasound findings,
The thickness of the gallbladder wall> 3 mm, intramural radiolucent image, distended gallbladder, cystic fluid pericopes hole and mud walls. The abdominal CT scan has greater sensitivity for the detection of acalculus cholecystitis.
Often the diagnosis is delayed and the disease progresses to ischemia, gangrene and perforation.
Treatment of the header is the percutaneous cholecystostomy cholecystectomy a few times
Have pleaded for the obstruction of the bile duct (CBD) results, the procedures for emergency relief in the form of endoscopic stenting, or open places of PTBD tube biliary drainage, and T
Mortality is high in the range 30% of AAC, but early treatment may be an effective cure.