Perioperative Predictors of Acute Cholecystitis After Cardiovascular Surgery

Rady, Mohamed Y.; Kodavatiganti, Ramesh; Ryan, Thomas

doi:10.1378/chest.114.1.76

Cited by 43 publications

(35 citation statements)

References 23 publications

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“…In fact, anomalies of GB are extremely common and could be found in up to 84% of the critically ill as a result of various causes [1, 2, 23]. However, we found that only 5.7% of the patients developed AAC requiring surgical intervention which is higher than that reported in the literature [6–8]. In a previous study, 14 out of 28 critical care patients (50%; 19 intubated) were found to have one of the three major sonographic criteria for AAC, but none of these subjects needed any intervention [23].…”

Section: Discussioncontrasting

confidence: 52%

“…Critical care patients have many risk factors for acute acalculous cholecystitis (AAC) which is an acute inflammation of the GB in the absence of gallstones and accounts for 2–14% of all cases of acute cholecystitis [3–5]. AAC is an insidious complication that has been increasingly recognized in the critically ill with an incidence ranging from 0.2 to 3% [6–8]. …”

Section: Introductionmentioning

confidence: 99%

“…Although the etiology is uncertain, AAC in the ICU has been associated with prolonged enteral fasting, total parenteral nutrition (TPN), duration of mechanical ventilation (MV) and the use of positive end-expiratory pressure (PEEP), activation of factor XII, trauma, sepsis, drugs (opiates, sedatives, and vasopressors), multiple transfusions, dehydration, and shock states [6, 9, 10]. Ultimately these factors may lead to bile stasis and GB hypoperfusion/ischemia resulting in acute inflammation of the GB.…”

Section: Introductionmentioning

confidence: 99%

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Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Myrianthefs

Evodia

Vlachou

et al. 2012

Critical Care Research and Practice

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Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU). Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy's sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6 ± 2.8 years; APACHE II score 21.3 ± 0.9; mean ICU stay 35.9 ± 4.8 days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Myrianthefs

Evodia

Vlachou

et al. 2012

Critical Care Research and Practice

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“…While positive bile cultures with enteric organisms have been found in 42-63% in acute calculous cholecystitits (25,26), they have been reported less frequently in AAC (28%) (4). The portion of positive cultures in our series was even lower both in USguided puncture (6%) and in surgical specimens (10%).…”

Section: Discussioncontrasting

confidence: 49%

Acute acalculous cholecystitis in critically ill patients

Laurila

Syrjälä

Laurila

et al. 2004

Acta Anaesthesiol Scand

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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%

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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Perioperative Predictors of Acute Cholecystitis After Cardiovascular Surgery

Cited by 43 publications

References 23 publications

Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Acute acalculous cholecystitis in critically ill patients

Tight Junction Proteins in Gallbladder Epithelium

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