Acalculous Cholecystitis Characteristic of acalculous disease: Acute gallbladder inflammation complicating severe underlying illness Ultrasound, CT, or radionuclide examinations: Large, tense, static gallbladder without stones and with evidence of poor emptying over a prolonged period Management: Early diagnosis and surgical intervention, with meticulous attention to postoperative care

Acalculous Cholecystopathy Disordered motility of the gallbladder The following criteria can be used for identification: – Recurrent episodes of typical RUQ pain characteristic of biliary tract pain – Abnormal CCK cholescintigraphy demonstrating a gallbladder ejection fraction of <40% – Infusion of CCK reproduces the pain Ultrasound: Large gallbladder Sphincter of Oddi dysfunction: Recurrent RUQ pain and CCK-scintigraphic abnormalities

Emphysematous Cholecystitis Acute cholecystitis Ischemia or gangrene of gall bladder wall Infection by gas producing organism such as C. welchii C. perfringens, or E. coli Common in the elderly and those with DM Clinical manifestations similar to nongaseous cholecystitis

Diagnosis with plain abdominal film Gas within gall bladder lumen Gaseous ring Prompt surgical intervention with antibiotic therapy mandatory Considerable morbidity Emphysematous Cholecystitis

Chronic Cholecystitis Repeated bouts of subacute or acute cholecystitis Persistent mechanical irritation of gallbladder wall by gall stones Bacteria in bile in >25% of patients with chronic cholecystitis May be asymptomatic for years May progress to symptomatic gallbladder disease or to acute cholecystitis, or present with complications