Acute acalculous cholecystitis in critically ill patients

Laurila, Jouko; Syrjälä, Hannu; Laurila, Päivi; Saarnio, Juha; Ala‐Kokko, Tero

doi:10.1111/j.0001-5172.2004.00426.x

Cited by 85 publications

(64 citation statements)

References 22 publications

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“…[4][5][6][7][8][9][10] It is clinically indistinguishable from acute calculous cholecystitis and the findings of right upper quadrant pain, fever, leukocytosis and abnormal liver function tests are non-specific clinical findings of AAC. Critically ill patients are more susceptible to developing AAC, but trauma is a well-known risk factor.…”

Section: Discussionmentioning

confidence: 99%

Acute acalculous cholecystitis after blunt abdominal trauma

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Acute acalculous cholecystitis after blunt abdominal trauma

et al. 2016

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“…The mechanism of upper abdominal pain in patients with congestive heart failure is to occur mainly from the expansion of hepatic cells by elevated sinusoidal pressure caused by cholestasis [10]. An additional mechanism of congestive heart failure due to gallbladder edema and infection may cause decreased blood flow in cystic artery, leading to acalculous cholecystitis [10]. Not only with imaging modalities but also with clinical symptoms and manifestation, it was crucial to recognize the presence of congestive heart failure in …”

Section: Discussionmentioning

confidence: 99%

A Case of Peripartum Cardiomyopathy Affected by Left Ventricle Thrombus

Takeuchi¹,

Emori²,

Soneda³

et al. 2016

J Med Cases

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Peripartum cardiomyopathy (PPCM) mimicking dilated cardiomyopathy is defined as an idiopathic cardiomyopathy affecting perinatal or postnatal women with no cardiac history. It occurs in 1 in 20,000 births in Japan. A 25-year-old female without cardiology diseases presented to our hospital's emergency department with upper abdominal pain, exertional dyspnea, and leg edema. One month prior, she gave birth to her first child via vaginal delivery. At 36 weeks of gestation, she was diagnosed with pregnancy hypertension by an obstetrician. Ultrasonography and non-contrast computed tomography were performed and revealed an edematous gallbladder as well as dilated hepatic and inferior jugular veins. Chest X-ray revealed cardiomegaly, lung edema, and pleural effusion. She was diagnosed with congestive heart failure. Transthoracic echocardiogram (TTE) revealed a dilated left ventricle with a reduced ejection fraction (EF) of 17%. Immediately after admission, diuretic agents, including furosemide and carperitide, were administered. Although her heart failure improved with sufficient diuretic treatment, thromboses measuring 16 × 8 and 29 × 11 mm in her left ventricle were revealed by TTE on day 10. Heparin sodium and warfarin potassium were initiated, which reduced the thromboses. Her symptoms improved, although EF was not restored to normal function. She was discharged on day 40 and an outpatient clinic follow-up was scheduled. Long-term prognosis of PPCM is currently unknown, and meticulous follow-up of the patient is required. Here we present a case of PPCM that was affected by a left ventricular thrombus.

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“…(J Histochem Cytochem 55:567-573, 2007) K E Y W O R D S acalculous cholecystitis cholecystitis claudins critical illness gallbladder occludin tight junction ACUTE CALCULOUS CHOLECYSTITIS (ACC) is caused by obstruction of the cystic duct by gallstones, leading to distention, edema, bile stasis, inflammation and, often, bacterial infection of the gallbladder. Acute acalculous cholecystitis (AAC) is an acute inflammation of the gallbladder in the absence of gallstones and has been shown to be associated with multiorgan dysfunction syndrome (MODS) of critically ill patients (Kalliafas et al 1998;Rady et al 1998;Barie and Eachempati 2003;McChesney et al 2003;Laurila et al 2004). The major clinical manifestations of MODS involve increased vascular and intestinal permeability, leading to significant edema and loss of gut barrier function (Pastores et al 1996;Swank and Deitch 1996;Doig et al 1998).…”

Section: S U M M a R Ymentioning

confidence: 99%

“…In the years 2000 and 2001, 39/3984 ICU patients underwent cholecystectomy because of AAC during their ICU stay. A detailed report of the clinical features of these 39 patients has been previously published (Laurila et al 2004). Typical histopathological features in the gallbladder wall in AAC are bile infiltration, lymphatic dilatation, and leukocyte margination of blood vessels, whereas typical features in ACC are epithelial degeneration and defects and widespread occurrence of inflammatory cells (Laurila et al 2005).…”

Section: Patientsmentioning

confidence: 99%

Tight Junction Proteins in Gallbladder Epithelium

Laurila

Karttunen

Koivukangas

et al. 2007

J Histochem Cytochem.

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S U M M A R YThere is a paucity of information of tight junction (TJ) proteins in gallbladder epithelium, and disturbances in the structure of these proteins may play a role in the pathogenesis of acute acalculous cholecystitis (AAC) and acute calculous cholecystitis (ACC). Using immunohistochemistry, we investigated the expression of TJ proteins claudin-1, -2, -3, and -4, occludin, zonula occludens (ZO-1), and E-cadherin in 9 normal gallbladders, 30 gallbladders with AAC, and 21 gallbladders with ACC. The number of positive epithelial and endothelial cells and the intensity of the immunoreaction were determined. Membrane-bound and cytoplasmic immunoreactivities were separately assessed. We found that TJ proteins were uniformly expressed in normal gallbladder epithelium, with the exception of claudin-2, which was present in less than half of the cells. In AAC, expression of cytoplasmic occludin and claudin-1 were decreased, as compared with normal gallbladder. In ACC, expression of claudin-2 was increased, and expression of claudin-1, -3, and -4, occludin, and ZO-1 were decreased, as compared with normal gallbladder or AAC. We conclude that there are significant differences in expression of TJ proteins in AAC and ACC, supporting the idea that AAC represents a manifestation of systemic inflammatory disease, whereas ACC is a local inflammatory and often infectious disease. (J Histochem Cytochem 55:567-573, 2007)

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Acute acalculous cholecystitis in critically ill patients

Abstract: Acute acalculous cholecystitis was associated with severe illness, infection, long ICU stay, and multiple organ failure. Mortality was related to the degree of organ failure. Prompt diagnosis and active treatment of AAC can be life-saving in these patients.

Cited by 85 publications

References 22 publications

Acute acalculous cholecystitis after blunt abdominal trauma

Acute acalculous cholecystitis after blunt abdominal trauma

A Case of Peripartum Cardiomyopathy Affected by Left Ventricle Thrombus

Tight Junction Proteins in Gallbladder Epithelium

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