Acute Cholecystitis Flashcards
What is acute cholecystitis?
It is is defined as a condition in which there is inflammation of the gallbladder
What are the three risk factors associated with acute cholecystitis?
Gallstones
Infection
Immunosuppression
What is the most common risk factor associated with acute cholecystitis?
Gallstones
What are the two infections associated with acute cholecystitis?
Cryptosporidium
Cytomegalovirus
What are the nine clincial features of acute cholecystitis?
Fever > 38C
Nausea & Vomiting
Right Upper Quadrant Pain
Shoulder Pain
Murphy’s Sign
Boas’ Sign
Tachycardia
Tachypnoea
Hypertension
What is Murphy’s sign?
It is defined as inspiration arrest on palpation of the right upper quadrant
What is Boas sign?
It refers to hyperasthesia beneath the right scapula
It occurs due to abdominal wall innervation of this region from the spinal roots that lie at this level
What are the three investigations used to diagnose acute cholecystitis?
Blood Tests
Ultrasound Scan
Hepatobiliary Iminodiacetic Acid (HIDA) Scan
What are the seven blood test results indicative of acute cholecystitis?
Increased WCC Level
Increased CRP Lebel
Normal Bilirubin Level
Normal ALT Level
Normal AST Level
Normal ALP Level
Normal GGT Level
What differential diagnosis is indicated when liver function tests are deranged?
Mirizzi’s Syndrome
When are ultrasound scans used to diagnose acute cholecystitis?
It is the first line investigation used to diagnose acute cholecystitis
What are the four features of acute cholecystitis on ultrasound scan?
Sonographic Murphy’s Sign
Gallbladder Wall Thickening > 3mm
Gallbladder Distention
Pericholecystic Fluid
When are HIDA scans used to diagnose acute cholecystitis?
It is the second line investigation used to diagnose acute cholecystitis
What is a HIDA scan?
This involves IV injection of technetium labelled HIDA, which is taken up selectively by hepatocytes and excreted into bile
What is a feature of acute cholecystitis on HIDA scans? Explain
It is indicated by non-visualisation of the gallbladder four hours following injection
This is due to the fact that there is cystic duct obstruction secondary to oedema associated with inflammation or an obstructing gallstone
What is the pharmacological management option of acute cholecystitis?
IV Beta-Lactam Antibiotics
When are IV antibiotics used to manage acute cholecystitis?
They are used to manage acute cholecystitis related to infection
Name two antibiotics used to manage acute cholecystitis
Tazobactam
Sulbactam
What is the surgical management option of acute cholecystitis?
Laparoscopic Cholecystectomy
When is laparoscopic cholecystectomy used to manage acute cholecystitis?
It is recommended in all cases, within one week of diagnosis
When is laparoscopic cholecystectomy used to manage acute cholecystitis?
It is recommended in all cases, within one week of diagnosis
What is laparoscopic cholecystectomy?
It involves laparoscopic removal of the gallbladder
How do we differentiate between ascending cholangitis, acute cholecystitis and biliary colic?
In ascending cholangitis, individuals present with RUQ pain, fever and jaundice - with significant systemic features
In acute cholecystitis, individuals present with RUQ pain and fever - however systemic features are limited
In biliary colic, individuals present with RUQ pain, with absence of systemic features
