Sonomorphology of the gallbladder in critically ill patients

Helbich, Thomas H.; Mallek, R.; Madl, Christian; Wunderbaldinger, Patrick; Breitenseher, Martin; Tscholakoff, D; Mostbeck, G.

doi:10.1080/02841859709171256

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…Surely, routine evaluation of liver function tests for diagnosing AAC is neither specific nor sensitive. AAC represents an underdiagnosed entity in the ICU, and this may be partially due to the complexity of underlying medical and surgical problems and lack of reproducible signs and biochemical parameters [1, 6, 9]. Diagnosis of AAC and GB anomalies in general relies on a high level of clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, AAC is considered an ischemic rather than an infectious disorder, and any abdominal pain in a critically ill patient, or even unexplained fever or hemodynamic instability, warrants consideration of this diagnosis [2]. Prompt application of ultrasound investigations could confirm clinical suspicions and guide consequently therapeutic options [1, 9, 27, 28]. …”

Section: Discussionmentioning

confidence: 99%

“…Abdominal sonographic investigations were focused on the GB as previously described [1–4, 9]. AAC was defined as acute inflammation of the gallbladder in the absence of gallstones [12].…”

Section: Methodsmentioning

confidence: 99%

“…AAC was defined as acute inflammation of the gallbladder in the absence of gallstones [12]. Ultrasound findings that were evaluated included major criteria: gallbladder wall thickening (greater than 3 mm), striated (edematous) gallbladder wall, sonographic Murphy's sign, pericholecystic fluid in the absence of ascites, and hypoalbuminemia and minor criteria: gallbladder distention (hydrops with a long-axis caliper over 100 mm and a short axis (transverse diameter) over 50 mm) and biliary or gallbladder sludge [1, 2, 9, 13, 14]. Hepatic dysfunction was defined as bilirubin >2 mg/dL and/or alkaline phosphatase (ALP) >200 IU/L [15].…”

Section: Methodsmentioning

confidence: 99%

“…Although the etiology is uncertain, AAC in the ICU has been associated with prolonged enteral fasting, total parenteral nutrition (TPN), duration of mechanical ventilation (MV) and the use of positive end-expiratory pressure (PEEP), activation of factor XII, trauma, sepsis, drugs (opiates, sedatives, and vasopressors), multiple transfusions, dehydration, and shock states [6, 9, 10]. Ultimately these factors may lead to bile stasis and GB hypoperfusion/ischemia resulting in acute inflammation of the GB.…”

Section: Introductionmentioning

confidence: 99%

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Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Myrianthefs

Evodia

Vlachou

et al. 2012

Critical Care Research and Practice

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Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU). Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy's sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6 ± 2.8 years; APACHE II score 21.3 ± 0.9; mean ICU stay 35.9 ± 4.8 days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Abdominal sonographic investigations were focused on the GB as previously described [1–4, 9]. AAC was defined as acute inflammation of the gallbladder in the absence of gallstones [12].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Myrianthefs

Evodia

Vlachou

et al. 2012

Critical Care Research and Practice

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Amplitude-coded color Doppler: clinical applications

Turetschek

Kollmann²,

Dorffner

et al. 1999

European Radiology

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Amplitude-coded color Doppler sonography (ACD) has become an useful adjunct to gray-scale US and conventional color Doppler sonography (CD) for the assessment of vascular diseases and pathologic conditions that might affect or alter tissue vascularization or perfusion. Basically, all US units that generate conventional color Doppler information through autocorrelation technique are capable of displaying ACD. This technique is also referred to as power Doppler, amplitude-mode color Doppler US, color Doppler energy (CDE), or US angiography. Amplitude-coded color Doppler sonography has already emerged as a valuable adjunct to conventional CD, particularly for evaluating flow in parts of the body where CD signal is weak because of slow flow, small blood vessels, or both.

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