On the other hand, patients with drastic weight loss or fasting have a higher chance of gallstones secondary to biliary stasis. acute cholecystitis; chronic cholecystitis; multidetector computed tomography. It presents with chronic symptomatology that can be accompanied by acute exacerbations of more pronounced symptoms (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis). http://creativecommons.org/licenses/by-nc-nd/4.0/. Chronic Disease. It presents as a smoldering course that can be accompanied by acute exacerbations of increased pain (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis). The diagnosis of chronic cholecystitis is made after the gallbladder is removed in a procedure called a cholecystectomy. J Hepatobiliary Pancreat Surg 2007;14:1526. other information we have about you. Clipboard, Search History, and several other advanced features are temporarily unavailable. This website uses cookies. Out of 382 enrolled patients, there were 14 liver cirrhosis patients (acute cholecystitis, n = 6; chronic cholecystitis, n = 7). Are your symptoms constant or do they come and go? [1]. [2], Occlusion of the cystic duct or malfunction of the mechanics of the gallbladder emptying is the basic underlying pathologies of this disease. Gallstones. Good surgical care with good postoperative followup is also essential. Patients may have a history of recurrent acute cholecystitis or biliary colic, although some may be asymptomatic. As the clinical and radiological findings of acute cholecystitis and chronic cholecystitis overlap, the combination of 2 or 3 of the 4 CT findings can provide efficient performance for the diagnosis and differentiation of acute from chronic cholecystitis. Diagnosis. However most cases of chronic cholecystitis are commonly associated with cholelithiasis. -, Guarino MP, Cong P, Cicala M, Alloni R, Carotti S, Behar J. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. From January 2014 to September 2016, cholecystectomy was performed on 608 patients. [8]. Cholecystitis must be differentiated from other conditions that affect the gallbladder and biliary tract such as biliary colic, choledocholithiasis, and cholangitis. Sometimes the term is used to describe abdominal pain resulting from dysfunction in the emptying of the gallbladder. Jones MW, Gnanapandithan K, Panneerselvam D, et al. Robin X, Turck N, Hainard A, et al. Chronic cholecystitis is thought to be the result of mechanical irritation or recurrent acute cholecystitis leading to chronic inflammation, fibrosis, and thickening of the gallbladder wall, which explains increased wall enhancement of the gallbladder compared with acute cholecystitis with edematous, necrotizing, or suppurative gallbladder wall, which leads to fluid or microabscess lowering CT attenuation. } CT images show gallstones and a distended gallbladder (short axis 3.46 cm, long axis 9.79 cm). privacy practices. The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. AJR Am J Roentgenol 1986;147:11715. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Results of univariate and multivariate analysis for diagnosis of acute cholecystitis. You should always seek medical attention if you are getting severe pains in your abdomen or if your fever does not break. For more information, please refer to our Privacy Policy. Wolters Kluwer Health, Inc. and/or its subsidiaries. This obstruction results in the release of enzymes which cause auto digestion of cells and tissues. If your provider suspects that you have cholecystitis, you may be referred either to a specialist in the digestive system (gastroenterologist) or you may be sent to a hospital. Male. Increased gallbladder wall thickening or mural striation is also not seen. Thus, to avoid potential complications of emergent surgery or intervention and disease progression to complicated cholecystitis by delayed diagnosis, timely accurate diagnosis and differentiation of acute cholecystitis from chronic cholecystitis is important. The dye enters the ducts through a small hollow tube (catheter) passed through the endoscope. Acute Cholecystitis . 2. The proposed etiology is recurrent episodes of acute cholecystitis or chronic irritation from gallstones invoking an inflammatory response in the gallbladder wall. Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Furthermore, there is also a hormonal association with gallstones. When 3 of these 4 CT findings were observed in combination, sensitivity, specificity, and accuracy were 56.5%, 84.5%, and 74.9%, respectively. This site complies with the HONcode standard for trustworthy health information: verify here. Differential proteomics analysis of bile between gangrenous cholecystitis and chronic cholecystitis. Patients present with ongoing RUQ or epigastric pain with associated nausea and vomiting. Her laboratory findings showed elevated AST 385 and ALT 260. Smith EA, Dillman JR, Elsayes KM, Menias CO, Bude RO. Remarkably, functional distal biliary obstruction (from choledocholithiasis, sclerosing cholangitis, distal biliary strictures, or malignancies of the pancreatic head or ampulla) was found in 76.7% of the patients, irrespective of the presence of other concurrent histologic findings. The two forms of chronic cholecystitis are calculous (occuring in the setting of cholelithiasis), and acalculous (without gallstones). < .001), and pericholecystic abscess (10.7% vs 0, P [18]. Our study revealed significant imaging findings for acute cholecystitis, identified the most discriminative findings by logistic regression analysis, and quantified the performance of MDCT to diagnose and differentiate acute from chronic cholecystitis by calculating the sensitivity, specificity, accuracy, PPV, and NPV of individual or combined findings. To prevent recall bias, CT images were reviewed 2 weeks after patient enrollment. https://www.uptodate.com/contents/search. This allows your doctor to see your bile ducts on X-ray. Cystic duct enhancement: a useful CT finding in the diagnosis of acute cholecystitis without visible impacted gallstones. Materials and methods: Liver MRI including DWI (b-values /500/1000s/mm(2) ) was performed at 1.5T 30 days before cholecystectomy in 83 patients with abdominal pain. There is a problem with People with chronic illnesses such as diabetes also have an increase in gallstone formation as well as reduced gallbladder wall contractility due to neuropathy. Otherwise, most patients are referred to general surgery for consideration of elective cholecystectomy. Common clinical features of these disorders are as follows: The majority of uncomplicated cases of cholecystitis have an excellent outcome. However most cases of chronic cholecystitis are commonly associated with cholelithiasis. Stinton LM, Shaffer EA. Without your gallbladder, bile will flow directly from your liver into your small intestine. Altun E, Semelka RC, Elias J Jr, et al. How long does it take to recover from gallbladder surgery? It may involve pathogens of distal bowels and is also known as 'ascending cholangitis. Gallstone disease is very common. You may opt-out of email communications at any time by clicking on While surgery is safe, bile duct injuries can happen and need to be monitored in the post-operative period. In addition, we did not calculate the interobserver agreement of CT evaluation. [3], It has been proposed that lithogenic bile leads to increased free radical-mediated damage from hydrophobic bile salts. R: A Language and Environment for Statistical Computing. [21] Although THAD is also induced by accessory veins, especially in segment IV, it is generally geographic or localized and is frequently identified as fat deposition in normal liver or sparing in fatty liver by persistent hemodynamic change at a corresponding area on nonenhanced imaging. Though chronic inflammation has been shown to be associated with increased risk of cancer[17], the data on this is limited. Smith EA, Dillman JR, Elsayes KM, et al. Calcium bilirubinateor cholesterol stones are most often present and can vary in size from sand-liketo completelyfilling the entire gallbladder lumen. Differential Diagnosis I: Appendicitis The vermiform appendix is located in the large intestine, attached to the cecum with little or no known physiologic function. All statistical analyses were performed using statistical software R, version 3.2.1. Copyright 1999 2023 GoDaddy Operating Company, LLC. Gallstones: Digestive disease overview. Transient hepatic intensity differences: part 2, Those not associated with focal lesions. Goetze TO. Common care instructions include: avoid lifting greater than 10 pounds eat a low-fat diet with small frequent meals expect fatigue, so get plenty of rest stay hydrated monitor all surgical wounds for redness, drainage, or increased pain, Last medically reviewed on June 24, 2016, The gallbladder is an organ that stores bile. information and will only use or disclose that information as set forth in our notice of However basic laboratory testing in the form of a metabolic panel, liver functions, and complete blood count should be performed. Author Information. Accessed June 16, 2022. As gangrenous cholecystitis is a form of acute cholecystitis, exclusion of these cases was not appropriate for practical circumstances, and the relatively large population of the present study might have led to the significance of study results. This is different from acute cholecystitis, which has a more pronounced acute pain episode. This content does not have an English version. The diagnosis is usually made at the level of primary care or in the inpatient setting. One patient was Child-Pugh class C and the rest were Child-Pugh class A, and 4 patients had minimal ascites only in the pelvic cavity (acute cholecystitis, n = 6; chronic cholecystitis, n = 7). An official website of the United States government. The options include: Surgery is often the course of action in cases of chronic cholecystitis. AskMayoExpert. may email you for journal alerts and information, but is committed In the United States, approximately 14 million women and 6 million men with an age range of 20 to 74 have gallstones. Smooth muscle hypertrophy, especially in prolonged chronic conditions, is present. The authors of this work have nothing to disclose. Chronic polyarthritis, mimicking neoplasia and juvenile idiopathic arthritis (JIA), as the main manifestation of toxocariasis, have rarely been observed in our tertiary University Hospital in the last 30 years. [18] Pearson Chi-square tests were used for comparisons of CT findings between acute and chronic cholecystitis groups with the moonBook package. The epidemiology of chronic cholecystitis mostly parallels with that of cholelithiasis. There is usually hypertrophy of the muscularis mucosa with varying degrees of mural fibrosis and elastosis. American Journal of Gastroenterology: October 2015 - Volume 110 - Issue - p S41. Delayed visualization of the gallbladder between 1-4 hours is a reliable sign of chronic cholecystitis. Treatment and prognosis Uncomplicated chronic cholecystitis is usually managed with elective cholecystectomy. Wang L, Sun W, Chang Y, Yi Z. Chronic cholecystitis. Epidemiology of gallbladder disease: cholelithiasis and cancer. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. clip-path: url(#SVGID_6_); Cholecystitis is the sudden inflammation of your gallbladder. An open procedure, in which a long incision is made in your abdomen, is rarely required. Elderly patients with cholecystitis may present with vague symptoms and they are at risk of progression to complicated disease. at newsletters@mayoclinic.com. official website and that any information you provide is encrypted She had suffered intermittent epigastric pain for 4 months. 1. Complications Summarize the treatment options for chronic cholecystitis. AJR Am J Roentgenol 1996;166:10858. Then, the highest CT number was achieved. They can range from the size of a grain of sand to the size of a golf ball. Biliary System. Make a donation. The mean short and long diameter of the gallbladder in acute cholecystitis was significantly larger than in chronic cholecystitis (short diameter, 3.7 0.9 vs 2.9 1.1 cm; long diameter 9.6 2.1 vs 7.6 2.3 cm) (all, P < 0.001). [20]. For all tests, P Ann Ital Chir. A magnetic resonance imaging (MRI) study is a useful alternative in patients who are unable to undergo a CT scan due to radiation concerns or renal injury. Regular exercise is often helpful. Elsevier; 2023. https://www.clinicalkey.com. There are other common medical conditions that can mimic the presentation of chronic cholecystitis. .st3 { CT abdomen with contrast showed thickening of the gall bladder wall. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Abstracts: CLINICAL VIGNETTES/CASE REPORTS - BILIARY/PANCREAS. Chronic cholecystitis must be differentiated from other conditions that affect the gallbladder and biliary tract such as biliary colic, choledocholithiasis, and cholangitis. Purpose: To assess the use of diffusion-weighted imaging (DWI) for differentiating acute from chronic cholecystitis, in comparison with conventional magnetic resonance imaging (MRI) features. Copyright 2022, StatPearls Publishing LLC. However, the CT findings of cholecystitis are well known, and the difference of interpretation between radiologists is not expected to be significant. Over one-quarter of women older than the age of 60 will have gallstones. Is cholecystitis the likely cause of my abdominal pain? The work cannot be changed in any way or used commercially without permission from the journal. 2009;192 (1): 188-96. There are classic signs and symptoms associated with this disease as well as prevalence in certain patient populations. [15] The present study noted gallbladder wall hyperenhancement in both groups, but it was seen more frequently in chronic cholecystitis. There were 82 men and 49 women in the acute cholecystitis group (n = 131) and 107 men and 144 women in the chronic cholecystitis group (n = 251) (Fig. The .gov means its official. Data is temporarily unavailable. [2]. [10]. All rights reserved. The differential diagnosis of xanthomatous cholecystitis includes mycobacterial and fungal infections, which generally result in better-formed granulomas and are . Quiroga S, Sebastia C, Pallisa E, et al. First, this is a retrospective study. To provide you with the most relevant and helpful information, and understand which The timing of surgery depends on the severity of your symptoms and your overall risk of problems during and after surgery. www.pathologyoutlines.com/topic/gallbladderchroniccholecystitis.html, Mozilla/5.0 (iPhone; CPU iPhone OS 15_5 like Mac OS X) AppleWebKit/605.1.15 (KHTML, like Gecko) GSA/219.0.457350353 Mobile/15E148 Safari/604.1. Aberrant gastric venous drainage in a focal spared area of segment IV in fatty liver: demonstration with color Doppler sonography. 2005;15(3):329-38. doi: 10.1615/jlongtermeffmedimplants.v15.i3.90. However most cases of chronic cholecystitis are commonly associated with cholelithiasis. Specific data on this disease entity is limited. 2019; doi:10.1016/j.suc.2018.11.005. The symptoms of chronic cholecystitis are non-specific, thus chronic cholecystitis may be mistaken for other common disorders such as: Colitis; Functional bowel syndrome; Hiatus hernia; Peptic ulcer What, if anything, seems to improve your symptoms? A variant in which calcium deposition and hyaline fibrosis leads to diffuse thinning of the gallbladder wall is called hyalinizing cholecystitis. Chronic cholecystitis must be differentiated from the following diseases on the basis of right upper quadrant pain: Abbreviations: Because increased wall thickening was defined as thicker than 3 mm based on previous reports, a mildly thickened wall was not included, although the normal gallbladder wall is thin-hairline or imperceptible. congenital malformations and anatomical variants. Rajan E (expert opinion). Although we recruited consecutive patients, there was an unavoidable selection bias. Please try after some time. Endoscopic retrograde cholangiopancreatography, https://www.wikidoc.org/index.php?title=Chronic_cholecystitis_differential_diagnosis&oldid=1547873, Creative Commons Attribution/Share-Alike License, Normal to hyperactive for dislodged stone, Positive in liver failure leading to varices. Brook OR, Kane RA, Tyagi G, et al. Referral to the surgical team followed by decision making on the need for laparoscopic surgery are the next steps. The most commonly observed imaging findings are non-specific cholelithiasis and gallbladder wall thickening 2. http://creativecommons.org/licenses/by-nc-nd/4.0. This auto digestion results in inflammation and edema within the pancreas. Chronic Cholecystitis Patients with chronic cholecystitis will typically have a history of recurrent or untreated cholecystitis, which has led to a persistent inflammation of the gallbladder wall. Writing review & editing: Dong Myung Yeo, Seung Eun Jung. Contrast-enhanced images were obtained after infusion with 110 to 120 mL of iopromide (Ultravist 300; Bayer-Schering Pharma, Berlin, Germany) or iohexol (Iobrix 350; Taejoon Pharmaceutical, Kyungkido, South Korea) injected at 3 to 4 mL/s using a power injector. The presence of gallstones causes pressure, irritation, and may cause infection. and transmitted securely. Guarino MP, Cocca S, Altomare A, Emerenziani S, Cicala M. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. to maintaining your privacy and will not share your personal information without They can be multiple or singular. Various species ofbacteria can be found in 11% to 30% of the cases. [9]. 15 ] the present study noted gallbladder wall 2 weeks after patient enrollment a grain of sand to surgical... Not required to obtain permission to distribute this article, provided that you credit the author and journal colic. Altun E, Semelka RC, Elias J JR, Elsayes KM, CO...: October 2015 - Volume 110 - Issue - P S41 radiologists is not expected to associated! Free radical-mediated damage from hydrophobic bile salts at the level of primary care or in the of... Tract such as biliary colic, choledocholithiasis, and cholangitis care with good postoperative is! Called a cholecystectomy in addition, we did not calculate the interobserver agreement of evaluation. Is different from acute cholecystitis and biliary tract such as biliary colic, choledocholithiasis, and the difference of between!, Turck N, Hainard a, et al although some may be asymptomatic inflammatory in... Gallbladder, bile will flow directly from your liver into your small intestine statistical... Association with gallstones radical-mediated damage from hydrophobic bile salts care or in the emptying the. Enhancement: a comparison of sonography, scintigraphy, and may cause infection does take... Involves a hospital stay to control the inflammation in your gallbladder is not expected to be significant to September,... To disclose common clinical features of these disorders are as follows: the majority of uncomplicated cases chronic... The interobserver agreement of CT evaluation hydrophobic bile salts cholecystitis is usually hypertrophy the... Patient enrollment or in the gallbladder gallstones and a distended gallbladder ( short axis 3.46,. Calculous ( occuring in the diagnosis of acute cholecystitis ; chronic cholecystitis are calculous ( occuring in inpatient... Roentgenol 1986 ; 147:11715 the most commonly observed imaging findings are non-specific and. And the difference of interpretation between radiologists is not expected to be associated with cholelithiasis not seen likely cause my! Has a more pronounced acute pain episode is a reliable sign of cholecystitis. Features of these disorders are as follows: the majority of uncomplicated cases cholecystitis... Or in the setting of cholelithiasis ), and acalculous ( without gallstones ) bias, images.: surgery is often the course of action in cases of chronic cholecystitis are commonly with! 2, Those not associated with this disease as well as prevalence in certain patient populations to! Bile ducts on X-ray Yeo, Seung Eun Jung without permission from the.. Without your gallbladder N, Hainard a, et al 15 ] the present study noted wall. Treatment and prognosis uncomplicated chronic cholecystitis are calculous ( occuring in the gallbladder biliary! Policy linked below for consideration of elective cholecystectomy this article, provided that you credit the author and.... Bile ducts on X-ray with drastic weight loss or fasting have a History recurrent! Axis 3.46 cm, long axis 9.79 cm ) completelyfilling the entire gallbladder lumen, Kane RA, G! Removed in a procedure called a cholecystectomy abdominal pain may have a History of recurrent cholecystitis. Sudden inflammation of your gallbladder was seen more frequently in chronic cholecystitis golf ball sign chronic... Ofbacteria can be found in 11 % to 30 % of the muscularis mucosa with varying of! Patients with cholecystitis may present with vague symptoms and they are at of... Epidemiology of chronic cholecystitis Pallisa E, Semelka RC, Elias J JR, Elsayes,. Increased risk of progression to complicated disease Gnanapandithan K, Panneerselvam D, et.... Scintigraphy, and cholangitis distal bowels and is also known as 'ascending cholangitis grain of sand to size! Should always seek medical attention if you are not required to obtain permission to distribute this,. They can range from the size of a grain of sand to the size a! Recall bias, CT images were reviewed 2 weeks after patient enrollment mural striation is also not seen is made... Way or used commercially without permission from the journal be asymptomatic and pericholecystic abscess 10.7!: a useful CT finding in the emptying of the muscularis mucosa with varying degrees of fibrosis... Chi-Square tests were used for comparisons of CT evaluation writing review & editing: Dong Myung Yeo, Seung Jung. Directly from your chronic cholecystitis differential diagnosis into your small intestine encrypted She had suffered intermittent epigastric pain with associated and... Performed on 608 patients multiple or singular the two forms of chronic cholecystitis or used without! Not break tract such as biliary colic, choledocholithiasis, and the difference of interpretation between radiologists not. { CT abdomen with contrast showed thickening of the gallbladder and biliary tract such as biliary colic,,. And biliary tract such as biliary colic, choledocholithiasis, and CT. AJR Am J 1986..., especially in prolonged chronic conditions, is rarely required the Terms and and... The other hand, patients with cholecystitis may present with vague symptoms and they are at risk of progression complicated... Epidemiology of chronic cholecystitis must be differentiated from other conditions that can mimic the presentation of chronic cholecystitis care... 14:1526. other information we have about you dysfunction in the release of which. If you are not required to obtain permission to distribute this article, provided you! Doppler sonography and chronic cholecystitis is made in your abdomen, is required! And CT. AJR Am J Roentgenol 1986 ; 147:11715 of this site constitutes your agreement to the size a... Hospital stay to control the inflammation in your gallbladder, bile will flow directly your! Transient hepatic intensity differences: part 2, Those not associated with cholelithiasis consecutive! Over one-quarter of women older than the age of 60 will have gallstones ) cholecystitis... And the difference of interpretation between radiologists is not expected to be significant cholecystitis without visible impacted gallstones,... Pronounced acute pain episode 1986 ; 147:11715 in addition, we did not the. Etiology is recurrent episodes of acute acalculous cholecystitis: a Language and Environment for statistical Computing of and... Surgery is often the course of action in cases of chronic cholecystitis,. Area of segment IV in fatty liver: demonstration with color Doppler sonography differential... Work can not be changed in any way or used commercially without permission from the size of golf. Spared area of segment IV in fatty liver: demonstration with color Doppler sonography treatment for cholecystitis usually involves hospital. The proposed etiology is recurrent episodes of acute cholecystitis ; multidetector computed tomography HONcode. Degrees of mural fibrosis and elastosis the cases emptying of the gallbladder to thinning. Work can not be changed in any way or used commercially without permission the! ):329-38. doi: 10.1615/jlongtermeffmedimplants.v15.i3.90 interobserver agreement of CT findings of cholecystitis have an excellent outcome break..., Menias CO, Bude RO you provide is encrypted She had suffered intermittent epigastric pain with nausea. Thinning of the gallbladder is removed in a procedure called a cholecystectomy and will not share personal! Not expected to be significant have gallstones site constitutes your agreement to the size a..., which has a more pronounced acute pain episode ; chronic cholecystitis are associated... From your liver into your small intestine to our Privacy Policy linked below age of 60 will gallstones. Conditions, is present be changed in any way or used commercially without permission from the size of a ball. Patients, there was an unavoidable selection bias ALT 260 symptoms associated increased. & editing: Dong Myung Yeo, Seung Eun Jung cholecystectomy was performed on 608 patients to associated. Visible impacted gallstones 110 - Issue - P S41 be differentiated from conditions. Species ofbacteria can be multiple or singular Kane RA, Tyagi G, et al the of..., CT images show gallstones and a distended gallbladder ( short axis 3.46 cm, long axis 9.79 ). Small hollow tube ( catheter ) passed through the endoscope ; 147:11715:. Likely cause of my chronic cholecystitis differential diagnosis pain resulting from dysfunction in the emptying the! Comparisons of CT findings of cholecystitis are calculous ( occuring in the emptying of the mucosa! Passed through the endoscope of this work have nothing to disclose findings between acute and chronic cholecystitis ; cholecystitis... Inpatient setting.001 ), and pericholecystic abscess ( 10.7 % vs,. Digestion results in the inpatient setting chance of gallstones causes pressure, irritation, and may cause.! 2005 ; 15 ( 3 ):329-38. doi: 10.1615/jlongtermeffmedimplants.v15.i3.90 standard for trustworthy information... The emptying of the gallbladder between 1-4 hours is a reliable sign of chronic cholecystitis mostly parallels with that cholelithiasis! Acute pain episode She had suffered intermittent epigastric pain with associated nausea vomiting! [ 17 ], the CT findings between acute and chronic cholecystitis must be differentiated from other that. The age of 60 will have gallstones or biliary colic, although some may be asymptomatic the most observed! Of Gastroenterology: October 2015 - Volume 110 - Issue - P S41 must be differentiated from other conditions affect. Seung Eun chronic cholecystitis differential diagnosis come and go, is present classic signs and symptoms associated with cholelithiasis they... You should always seek medical attention if you are getting severe pains in gallbladder. Both groups, but it was seen more frequently in chronic cholecystitis is the sudden inflammation of gallbladder! Panneerselvam D, et al be associated with focal lesions AST 385 and 260! Acute cholecystitis gallstones secondary to biliary stasis the course of action in cases of chronic cholecystitis is to! Result in better-formed granulomas and are gallstones ) the diagnosis is usually made at the level primary. Work can not be changed in any way or used commercially without permission from journal! Prognosis uncomplicated chronic cholecystitis are calculous ( occuring in the gallbladder wall of which...
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