Acute acalculous cholecystitis may be suspected in a patient in the intensive care unit (ICU) when certain clinical and laboratory findings are present. Usually the diagnosis requires recognition of risk factors and a high index of suspicion. A delay in diagnosis can result in significant complications.


Clinical findings:

(1) right upper quadrant pain or diffuse abdominal pain

(2) palpable right upper quadrant mass

(3) fever >= 38°C

(4) unexplained sepsis


Laboratory findings:

(1) leukocytosis with white blood cell count >= 11,000 per µL

(2) elevated total serum bilirubin

(3) elevated serum alkaline phosphatase

(4) elevated transaminases

(5) elevated serum amylase


The diagnosis may be difficult if the patient:

(1) is sedated or receiving analgesics

(2) has had intra-abdominal surgery

(3) is comatose or altered mental status


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