Chronic Cholecystitis Differential Diagnosis Table

Chronic Cholecystitis Differential Diagnosis Table:

Chronic cholecystitis is the chronic inflammation of the gallbladder, usually caused by repeated attacks of acute cholecystitis. It usually occurs due to functional or structural damage of the gallbladder or bile ducts that affect its function in the secretion of bile, leading to inflammation and damage to the gallbladder.
Diagnosis of chronic cholecystitis is mainly based on imaging tests like ultrasound and CT scan; for further and detailed information, MRCP and ERCP can be used. ERCP is also used for treatment and removal of the gallbladder.
Symptoms of chronic cholecystitis may remain asymptomatic and come in attacks as acute cholecystitis. Usually, symptoms are severe abdominal pain radiating to the back, indigestion, and heartburn.
Usually, treatment of chronic cholecystitis is surgical removal of the gallbladder. This is a simple procedure that can be done endoscopically.

How to Distinguish Chronic Cholecystitis from Other Conditions

Distinguish Gallstones from Chronic Cholecystitis – Diagnosis

Gallstones are the presence of stones in the gallbladder; these stones are usually from bile acids buildup in the gallbladder causing hardening deposits, leading to inflammation in the gallbladder with symptoms of severe pain, especially after eating. In progressive cases, it can lead to jaundice as well. Treatment of gallstones usually involves removal of the gallbladder itself.

• Initial investigation with clinical presentation and symptoms of abdominal pain and patient history.
• Imaging tests like CT scan and ultrasound are usually used for detection of gallstones.
• MRCP and ERCP can be used in diagnosis and management of disease also can give detailed information about the condition and if there are any complications in the pancreas and bile duct.

“Gallstones themselves are a leading cause of chronic cholecystitis.”

Distinguish Acute Cholecystitis from Chronic Cholecystitis – Diagnosis

Acute cholecystitis is inflammation of the gallbladder that usually presents as sudden onset of severe abdominal pain. Repeated attacks of acute cholecystitis can lead to chronic cholecystitis. This can occur due to gallstones, though there are other causes and types of cholecystitis.

• Imaging tests like CT scan and ultrasound are usually diagnostic tests of choice, especially in the case of acute attacks they can help in giving a fast diagnosis.
• Blood tests for bilirubin and WBCs may be needed to rule out the presence of jaundice or infection.
• HIDA scan can also be used to check the flow of bile and contraction of the gallbladder itself.

Distinguish Peptic Ulcer Disease from Chronic Cholecystitis – Diagnosis

Peptic ulcer disease is the inflammation and discontinuation of the lining of the mucosal layer that protects the stomach against acids. The most common causes of peptic ulcer disease are H. pylori, NSAIDs, and stress-induced peptic ulcers. Usually, peptic ulcers can be treated with treatment, but if they progress into perforation, surgery may be necessary.

• Upper GI endoscope is the main diagnostic tool for confirmation of diagnosis.
• H. pylori tests like urea breath tests and stool tests are needed to know if it’s the reason for the condition.

Distinguish Pancreatitis from Chronic Cholecystitis – Diagnosis

Pancreatitis is the inflammation of the pancreas; it can either be acute or chronic inflammation. Although acute inflammation causes severe pain, chronic pancreatitis can lead to progressive damage in the organ. Cholecystitis itself, either acute or chronic, is a major cause of pancreatitis.

• CT scan with or without contrast is the initial diagnosis to detect any inflammation or swelling in the pancreas.
• ERCP and MRCP can be used to give detailed images, especially if the cause of pancreatitis is gallbladder problems.
• Serum blood tests of amylase and lipase are also essential to monitor disease progression and response to treatment.

Distinguish Gastritis from Chronic Cholecystitis – Diagnosis

Gastritis is the inflammation in the lining of the stomach. This can happen due to various reasons; medications, infections, or maybe an underlying condition like autoimmune disorders. In most cases, gastritis is a self-limited condition that resolves on its own with symptomatic treatment.

• Upper GI series; which is a series of x-rays with contrast barium to give images and detect any abnormality in the stomach.
• Upper endoscope to detect the presence of ulcers.
• Stool tests to detect the presence of infection; bacterial, viral, or parasitic.
• Blood tests and inflammatory markers are also needed.
• H. pylori tests like urea breath test and stool antigen test.

“Since gastritis is rather a manifestation more than a disease, a series of investigational tests is needed to confirm diagnosis and underlying cause.”

Distinguish Gastroesophageal Reflux Disease (GERD) from Chronic Cholecystitis – Diagnosis

Gastroesophageal reflux disease (GERD) is the reflux of stomach content and its acid back into the esophagus, causing a feeling of heartburn. This is usually due to a problem in the lower esophageal sphincter (LES), that it can’t close properly. As people get older, they have a greater risk of GERD. Treatment can manage symptoms of GERD, if it progresses it can lead to ulcers.

• Upper endoscope is usually the main diagnostic test for GERD to detect any functional abnormality in the sphincter and may detect any complications like ulcers.
• Ambulatory acid (pH) probe test which is a monitor placed in the esophagus to help in knowing the acid level in the esophagus.
• X-ray of the esophagus with barium swallow which will help to see any structural abnormalities in the esophagus.
• Esophageal manometry can help in detecting any problem in contractility in the esophagus or problems in LES.

Distinguish Irritable Bowel Syndrome (IBS) from Chronic Cholecystitis – Diagnosis

Irritable bowel syndrome is a condition causing abdominal pain and bloating. It usually doesn’t have an exact cause; people may relate it to stress or maybe immunity. Most times, people with IBS don’t have structural damage; they only have symptoms, which make the diagnosis of IBS challenging.

• Rome IV criteria is the main diagnostic tool that physicians use; it includes the average abdominal pain and discomfort within the last three months.

“Irritable bowel syndrome is categorized into types according to symptoms; mainly diarrhea or constipation.”

Distinguish Biliary Dyskinesia from Chronic Cholecystitis – Diagnosis

Biliary dyskinesia is a functional disorder in the gallbladder. This leads to a kind of peristalsis and inability of bile to move outside the bile duct, leading to bile buildup and forming of stones. The exact cause of biliary dyskinesia is not known. But if gallstones are formed, removal of the gallbladder is the main treatment.

⦁ HIDA or Cholescintigraphy is the main diagnostic tool for biliary dyskinesia; it can assess motility of bile in the gallbladder and bile duct.
⦁ Imaging tests like CT and ultrasound can diagnose gallstones but can distinguish underlying causes like biliary dyskinesia.

Distinguish Hepatitis from Chronic Cholecystitis – Diagnosis

Hepatitis is the inflammation of the liver. This commonly occurs due to viral infection of hepatitis A, B, C, D, or E. According to the type of infection, this condition can either be acute, self-limited, or chronic, leading to liver cirrhosis and liver carcinoma. Treatment of hepatitis can be managed medically, but if the disease progresses, liver transplantation may be needed.

• Serology testing of different virus types is needed in the initial investigation to detect antibodies.
• Blood tests like liver function tests are needed; they can help later to monitor the response of treatment.
• Imaging tests like CT scan and ultrasound can help detect inflammation to the liver and know the extent of damage.
• Rarely, a liver biopsy is needed if other tests come negative; this will give a detailed image of the condition.

Important Red Flags in Chronic Cholecystitis

Chronic cholecystitis is a condition that can be managed by treatment for a long time, but eventually, the patient may need surgical removal of the gallbladder.
Some red flags may present that require the patient to be hospitalized or need immediate medical attention like; severe pain that is not responding to analgesic, that means that the damage of the gallbladder has progressed and surgical removal may be required immediately.
Having a fever may indicate the presence of infection in the gallbladder and the presence of cholangitis; this may require antibiotics to treat this infection.
Presence of acute pancreatitis is an indication the disease has progressed badly affecting the pancreas; this requires treatment and observation for a while before any surgical intervention.