Cholecystitis Differential Diagnoses
The differential diagnoses for cholecystitis can be categorized into the following groups:
Single Most Likely Diagnosis
- Acute cholecystitis: This is the most likely diagnosis given the presentation of right upper quadrant pain, fever, and leukocytosis, which are classic symptoms of cholecystitis. The diagnosis is often confirmed by ultrasound showing gallstones and gallbladder inflammation.
Other Likely Diagnoses
- Biliary colic: This condition is caused by temporary obstruction of the cystic duct by a gallstone, leading to intermittent pain. It's a likely diagnosis if the patient's symptoms are episodic and related to eating fatty foods.
- Peptic ulcer disease: Gastric or duodenal ulcers can cause epigastric pain that may radiate to the right upper quadrant, mimicking cholecystitis. A history of NSAID use or Helicobacter pylori infection supports this diagnosis.
- Hepatitis: Inflammation of the liver can cause right upper quadrant pain and elevated liver enzymes, making it a possible alternative diagnosis.
Do Not Miss Diagnoses
- Perforated viscus: A perforation of the gallbladder or intestine can lead to peritonitis, which is a life-threatening condition. Severe abdominal pain, guarding, and rebound tenderness are red flags for this diagnosis.
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain and elevated pancreatic enzymes. A history of gallstones or alcohol use supports this diagnosis.
- Myocardial infarction: Cardiac ischemia can cause referred pain to the abdomen, making it essential to consider in patients with risk factors for coronary artery disease.
Rare Diagnoses
- Acalculous cholecystitis: This is a rare form of cholecystitis that occurs without gallstones, often in critically ill patients. It's essential to consider in patients with risk factors such as prolonged fasting, total parenteral nutrition, or severe illness.
- Mirizzi syndrome: A rare condition where a gallstone becomes impacted in the cystic duct, causing obstruction of the common bile duct and jaundice.
- Gallbladder cancer: A rare malignancy that can cause chronic right upper quadrant pain, weight loss, and jaundice. It's essential to consider in patients with a history of gallstones or chronic inflammation.