ACALCULOUS CHOLECYSTITIS

It is an inflammatory disease of the gallbladder without evidence of gallstones or cystic duct obstruction; it is a severe illness that is a complication of various other medical or surgical conditions. Duncan first recognized it in 1844 when a fatal case of acalculous cholecystitis complicating an incarcerated hernia was reported. The condition causes approximately 5%-10% of all cases of acute cholecystitis and is usually associated with more serious morbidity and higher mortality rates than calculous cholecystitis. It is most commonly observed in the setting of very ill patients (eg, on mechanical ventilation, with sepsis or severe burn injuries, after severe trauma. In addition, acalculous cholecystitis is associated with a higher incidence of gangrene and perforation compared to calculous disease.

The usual finding on imaging studies is a distended acalculous gallbladder with thickened walls (>3-4 mm) with or without pericholecystic fluid. Acalculous cholecystitis can be observed in patients with human immunodeficiency virus (HIV) infection, although it is a late manifestation of this disease.

CAUSES:-

Acalculous cholecystitis results from gallbladder stasis and ischemia, which then cause a local inflammatory response in the gallbladder wall. The majority of patients with acalculous cholecystitis have multiple risk factors. In some cases, specific primary infections predispose to acalculous cholecystitis. As an example, acalculous cholecystitis occurring in patients with acquired immunodeficiency syndrome (AIDS) and other immunosuppressed patients may be due to opportunistic infections such as microsporidia, Cryptosporidium, or cytomegalovirus. More often, however, these infections cause a cholangiopathy without cholecystitis. (See "AIDS cholangiopathy".)

PATHOGENESIS:-

Pathologically in patients with acalculous cholecystitis, endothelial injury, gallbladder ischemia, and stasis, lead to concentration of bile salts, gallbladder distension, and eventually necrosis of the gallbladder tissue. Once acalculous cholecystitis is established, secondary infection with enteric pathogens, including Escherichia coli, Enterococcus faecalis, Klebsiella spp, Pseudomonas spp, Proteus spp, and Bacteroides fragilis and related strains, is common. Perforation occurs in severe cases.

HOMEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are: -

• Chelidonium
• Lycopodium
• Calcarea carb
• Nux vomica.