All right, so welcome back to the Internet Book of Critical Care Podcast.

I'm here with Adam Thomas, and we're going to talk about a calculus coliscystitis.

Josh, I got to say I'm really happy we're finally doing this because I'm going to be honest,

me and culpa, I've screwed this up in the past, and it's something that's really easy to screw up.

Yeah, I think this is super challenging as far as making the diagnosis in diagnosing it appropriately and not over-diagnosing it or under-diagnosing it, and I wish I could claim to do that perfectly, and I just totally can't.

So let's talk about the big spectrum viewpoint here.

So the eagle eye view.

What kind of patients are getting this and what's it from? So it is possible for outpatients to get acalculus colostitis due to like lymphadopathy of the

orthoepatis and ascarous worms and the gallbladder and stuff like that. We're not going to

talk about that here. So what we're really talking about is acalculus coliocytis complicating patients

with pre-existing critical illness. So typically, these are folks who are super sick.

They're intubated.

They're sedated.

They're on analgesics.

And their gallbladder kind of stops really working.

Fluid builds up.

It gets distended.

And it can lead to this kind of progressive necrotizing colisitis, so to speak, which

is potentially very dangerous.

Eileas of the gallbladder causing badness, eh?

Exactly. So epidemiology here, it's rare, but we love our rare

things in ICU, so we always go looking for it. But how much of this acalculus colicestitis

...