Approach to the Critical Patient

Immediate priorities

Life-threatening presentations

Resuscitation priorities

Monitoring and targets

Hemodynamic monitoring

Escalation triggers

Critical escalation criteria

History

Presentation pattern

Classic symptom complex

Risk factors

Demographic and metabolic risk

Acalculous cholecystitis risk

Critically ill patient context

Atypical presentations

High-risk missed diagnoses

Physical Exam

Abdominal examination

Murphy sign

Peritoneal findings

Vital signs

Hemodynamic assessment

Systemic assessment

Jaundice and scleral icterus

Skin findings

Differential Diagnosis

Hepatobiliary causes

Biliary colic

Choledocholithiasis

Ascending cholangitis

Gastric and pancreatic causes

Acute pancreatitis

Peptic ulcer disease

Gastritis

Other abdominal causes

Hepatic abscess

Appendicitis

Right lower lobe pneumonia

Laboratory Tests

Inflammatory markers

White blood cell count

C-reactive protein

Liver function tests

Bilirubin

Alkaline phosphatase and GGT

Metabolic and renal labs

Lipase

Renal function and electrolytes

Blood cultures

Point-of-care testing

Urine pregnancy test

Diagnostic Tests

Scoring Systems

Tokyo Guidelines 2018 severity grading

Tokyo Guidelines 2018 diagnostic criteria

Ultrasound

First-line imaging modality

Diagnostic findings

Limitations

CT

Indications

Protocol

CT findings

MRI

Indications

MRCP specific findings

Limitations

Scoring Systems (continued 1)

HIDA scan (hepatobiliary iminodiacetic acid scintigraphy)

Disposition

Admission criteria

All confirmed cholecystitis requires admission

Surgical consultation timing

Early cholecystectomy indications

Transfer criteria

Transfer indications

Discharge criteria

Criteria for safe discharge after cholecystectomy

Non-operative discharge after conservative management

Treatment

Initial medical management

NPO and fluid resuscitation

Nasogastric decompression

Analgesia

NSAID analgesia

Opioid analgesia

Multimodal approach

Antibiotic therapy

Antibiotic indications

First-line regimens

Healthcare-associated and severe sepsis

Common biliary organisms

Surgical treatment

Laparoscopic cholecystectomy

Percutaneous cholecystostomy

Indications

Procedure details

Outcomes

Endoscopic and EUS-guided drainage

EUS-guided gallbladder drainage

Endoscopic transpapillary drainage

Special Populations

Pregnancy

Epidemiology and risk

Imaging considerations

Surgical management in pregnancy

Geriatric

Atypical presentation

Outcomes and mortality

Medication considerations

Pediatrics

Epidemiology

Clinical features

Diagnostic approach

Treatment in pediatrics

Background

Epidemiology

Incidence and prevalence

Acalculous cholecystitis epidemiology

Mortality

Pathophysiology

Calculous cholecystitis mechanism

Acalculous cholecystitis mechanism

Gallstone formation

Therapeutic Considerations

Early versus delayed cholecystectomy evidence

Antibiotic therapy evidence

Non-operative management options

ICD-10 classification

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for acute cholecystitis

Return to emergency department if

References

Guidelines and key sources

Primary evidence base

Society guidelines

Specialty guidelines

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.