Acute Appendicitis vs Acute Cholecystitis
Acute Appendicitis and Acute Cholecystitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acute Appendicitis vs Acute Cholecystitis at a glance
- Acute Appendicitis: Obstruction-driven inflammation of the appendix; classic periumbilical-to-RLQ pain with peritoneal signs.
- Acute Cholecystitis: Inflammation of the gallbladder, most often from a stone obstructing the cystic duct.
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Side-by-side comparison
| Feature | Acute Appendicitis | Acute Cholecystitis |
|---|---|---|
| At a glance | Obstruction-driven inflammation of the appendix; classic periumbilical-to-RLQ pain with peritoneal signs. | Inflammation of the gallbladder, most often from a stone obstructing the cystic duct. |
| Classic presentation | Periumbilical pain → migration to RLQ + anorexia + nausea + low-grade fever + RLQ tenderness with peritoneal signs.; Periumbilical pain migrating to RLQ over… | Postprandial RUQ pain lasting >6 h with fever, leukocytosis, and positive Murphy sign.; Constant, severe RUQ or epigastric pain lasting >6 h (vs <6 h in… |
| Workup / key labs | Clinical diagnosis supported by imaging. Histopathology confirms post-operatively.; CBC — mild to moderate leukocytosis (10-18,000) with left shift; very high… | Tokyo Guidelines (TG18): (A) local signs — Murphy sign, RUQ mass/pain/tenderness; (B) systemic signs — fever, leukocytosis, elevated CRP; (C) imaging… |
| Imaging | CT abdomen/pelvis with contrast — modality of choice in adults; sensitivity and specificity >95%; findings: dilated appendix >6 mm, wall thickening,… | RUQ ultrasound — first-line; findings: gallstones, gallbladder wall thickening >3 mm, pericholecystic fluid, sonographic Murphy sign, distended gallbladder;… |
| First-line treatment | NPO, IV fluids, analgesia, antiemetics; IV antibiotics covering Gram-negative and anaerobic flora — piperacillin-tazobactam, ceftriaxone + metronidazole, or… | NPO, IV fluids, analgesia (NSAIDs and opioids; morphine traditionally avoided over sphincter of Oddi concerns but clinically used); IV antibiotics —… |
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