Why Fever and Leukocytosis with Cholecystitis?

[Guest 360983]

I had a patient in the ER yesterday with cholecystitis. When she first came in, my preceptor was thinking sepsis because her WBC count was 24 and temperature was 103. The docs were also thinking of pancreatitis. The patient had a glucose that was 150-ish after not eating for 24 hours--maybe pancreatitis, maybe undiagnosed diabetes (she was young, but also obese). The lipase results weren't back by the end of the shift.

Anyways, I was curious about why cholecystitis presents with fever and leukocytosis. I've read Medscape, my patho book and random websites and all I can find is that these are presenting symptoms, not the why behind it. Or, do you think the fever & leukocytosis were related to possible pancreatitis?

[netglow, ASN, RN]

Keep this site handy for lots of stuff:

Acute Pancreatitis

[Twinmom06, ASN, APN]

I had cholecystitis, leading to lap chole over the summer - I didn't have a fever, but the surgeon did say that the bile in my gallbladder was definitely infected but fortunately it was contained to the organ and when they cut it out they bagged it so it didn't spread...possibly a bile infection (mine was enterococcus)

[ClearBlueOctoberSky]

Also, and I may be off base here, but think of what the body does during an inflammatory response. You are going to get leukocyte migration into the area to try to "take care of" whatever is causing the problem. The migration of leukocytes into the affected area will cause a release of additional resources from the bone marrow, causing the increase in the WBCs and the body is going to run a fever as a self defense mechanism to attempt to kill off whatever is making it feel bad.

If I am going at this the wrong way, please correct me. Anyone...Esme you have knack for explaining things...

[OCNRN63, RN]

Also, and I may be off base here, but think of what the body does during an inflammatory response. You are going to get leukocyte migration into the area to try to "take care of" whatever is causing the problem. The migration of leukocytes into the affected area will cause a release of additional resources from the bone marrow, causing the increase in the WBCs and the body is going to run a fever as a self defense mechanism to attempt to kill off whatever is making it feel bad.

If I am going at this the wrong way, please correct me. Anyone...Esme you have knack for explaining things...

You did a good job yourself. I was going to give the same answer.

[Guest 360983]

Thanks. That's what I figured, but I was surprised that the pt had such a large response. A bump in WBC and a shift to the left, sure, but a level that was more than twice our upper limits surprised me. It probably didn't help that it may have started 2 weeks prior.