42.Cholecystitis

Question 1

Cholecystitis - definition

Answer 1

Inflammation of the gallbladder

Question 2

Cholecystitis - types

Answer 2

Acute cholecystitis

Chronic cholecystitis

Question 3

Acute Cholecystitis - definition

Answer 3

Acute inflammation of the gall bladder

Question 4

Acute Cholecystitis - Etiology

Answer 4

Gallstones

Question 5

Acute Cholecystitis - Pathophysiology

Answer 5

4 main factors
o 1. Obstruction/stasis = distention of GB – blood flow + lymphatics is compromised = mucosal ischemia + necrosis – can become gangrenous + when complicated with infx = acute emphysematous cholecystitis (emphyema) – distended with pus

o 2. Chemical irritation – erosion of mucosa by stone – bile salts in stone are v. toxic to cells

o 3. Bacterial infx

o 4. Pancreatic reflux

Question 6

Acute Cholecystitis - clinical presentation

Answer 6

• RUQ pain that radiates to right scapula (Boas’ sign)

Fever

N/V

local peritoneum

+ve Murphy’s sign

+ve Ortners sign (tenderness when hand taps edge of right costal arch)

• If stones move to CBD = obstructive “jaundice
• Tender palpable mass = pathogenomic of acute cholecystitis

Question 7

Acute Cholecystitis- Diagnostic investigations

Answer 7

Blood = increased WBC

US – thick wall + shrunken GB showing
o Pericholecystic fluid
o Dilated CBD

• Plain axis = identifies ≈ 10% of cases (porcelain GB) – calcification of GB
• Cholescintigraphy
  o Only specific test for acute cholecystitis
  o IV inj of contrast – excreted by liver into biliary duct system
  o In acute cholecystitis – GB not seen as GB outlet of CBD is obstructed

Question 8

Acute Cholecystitis- Treatment

Answer 8

Conservative tx: Aim to create functional rest to GB, upper GI + relaxing spasm of sphincter of oddi

Upper GI = mouth, pharynx, oesophagus, stomach, mediastinum,

Demarcation = suspensory muscle of duodenum

Pain relief; IV fluids, Abx, Cholecystectomy (open/laparoscopic)

Question 9

Acute Cholecystitis- Complications:

Answer 9

perforation, pericholecystic abscess, internal fistula

Question 10

Chronic cholecystitis: caused by

Chronic cholecystitis Can cause

Answer 10

Recurrent attacks of biliary colic, with only temporary occlusion of cystic duct

Can cause inflam + scarring of neck of GB + cystic duct

Question 11

Chronic cholecystitis: Clinical presentation

Answer 11

vague Ab discomfort

distention

N/V

flatulence

fat intolerance – pain after ingestion of fatty meal

Question 12

Chronic cholecystitis: Diagnostic Investigations

Answer 12

Clinical Hx

US = gallstones

CBD obstruction

porcelain (calcification of GB) GB

oral cholecystography

Question 13

Chronic cholecystitis: Treatment

Answer 13

elective cholecystectomy