Acute Cholecystitis vs Cholelithiasis and Biliary Colic
Acute Cholecystitis and Cholelithiasis and Biliary Colic 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 Cholecystitis vs Cholelithiasis and Biliary Colic at a glance
- Acute Cholecystitis: Inflammation of the gallbladder, most often from a stone obstructing the cystic duct.
- Cholelithiasis and Biliary Colic: Gallstones in the gallbladder; transient cystic duct obstruction causes episodic RUQ pain.
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Side-by-side comparison
| Feature | Acute Cholecystitis | Cholelithiasis and Biliary Colic |
|---|---|---|
| At a glance | Inflammation of the gallbladder, most often from a stone obstructing the cystic duct. | Gallstones in the gallbladder; transient cystic duct obstruction causes episodic RUQ pain. |
| Classic presentation | 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 biliary colic); Radiation to right shoulder or interscapular area; Nausea and vomiting; Fever and chills; Anorexia; RUQ tenderness with positive Murphy sign (inspiratory arrest on… | Postprandial RUQ pain after fatty meal, lasting 1-5 h, recurrent over weeks to months, with gallstones on US.; Episodic, postprandial (especially after fatty meals) RUQ or epigastric pain; Pain builds over 15-30 min, plateaus, and resolves within 6 h (typically 1-5 h); Radiation to right scapula or interscapular area; Nausea, vomiting,… |
| Workup / key labs | Tokyo Guidelines (TG18): (A) local signs — Murphy sign, RUQ mass/pain/tenderness; (B) systemic signs — fever, leukocytosis, elevated CRP; (C) imaging characteristic of cholecystitis. Definite diagnosis requires 1 from A + 1 from B + imaging.; CBC — leukocytosis with left shift; BMP; LFTs — mildly elevated AST/ALT and alk phos (~30%);… | CBC, BMP, LFTs — all typically normal in uncomplicated biliary colic; Lipase — exclude pancreatitis; Elevated bilirubin or alk phos raises concern for CBD obstruction |
| Imaging | RUQ ultrasound — first-line; findings: gallstones, gallbladder wall thickening >3 mm, pericholecystic fluid, sonographic Murphy sign, distended gallbladder; Hepatobiliary iminodiacetic acid (HIDA) scan — most sensitive/specific; non-visualization of gallbladder after 1-4 h confirms cystic duct obstruction; used when ultrasound… | RUQ ultrasound — first-line; sensitivity >95% for gallstones >5 mm; identifies gallbladder wall, CBD diameter, signs of cholecystitis; MRCP — for suspected CBD stones; EUS — most sensitive for small CBD stones; HIDA scan — assesses gallbladder ejection fraction; <35% supports symptomatic gallbladder dysmotility (functional gallbladder… |
| First-line treatment | NPO, IV fluids, analgesia (NSAIDs and opioids; morphine traditionally avoided over sphincter of Oddi concerns but clinically used); IV antibiotics — piperacillin-tazobactam, ceftriaxone + metronidazole, or ertapenem (broaden for severity); Early laparoscopic cholecystectomy — within 72 h preferred; equivalent outcomes to delayed… | Asymptomatic cholelithiasis — observation; NO routine cholecystectomy; Symptomatic cholelithiasis (biliary colic) — elective laparoscopic cholecystectomy; Analgesia (NSAIDs preferred — also reduce risk of progression to cholecystitis); Antiemetics; Dietary advice — low-fat diet may reduce attacks while awaiting surgery |
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