Chronic Cholecystitis: Incorrect

Although most patients with acute cholecystitis previously had chronic cholecystitis, this is not the most likely diagnosis in this case. Chronic cholecystitis (Biliary colic) is characterized by episodic abdominal pain and dyspepsia, which resolves within minutes to a few hours. The pathophysiology of biliary colic appears to be a temporary obstruction of the cystic duct. If the obstruction does not resolve and the stone becomes more impacted, acute cholecystitis occurs. In chronic cholecystitis the patient may be uncomfortable but does not appear toxic. Laboratory values including LFTs and CBC is normal. No fever is present and there are no signs of systemic infection. An ultrasound exam of the RUQ often reveals stones in the gallbladder. Biliary colic may simulate duodenal ulcer, hiatal hernia, pancreatitis, and myocardial infarction and the appropriate tests to rule these out should be done if one is suspicious. This patient had a normal EKG.

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