Acute Cholecystitis Flashcards
What is acute cholecystitis caused by?
Cystic duct blockage preventing the gallbladder from draining
What is the most common cause of acute cholecystitis?
Gallstones (calculous cholecystitis) trapped in the neck of gallbladder or cystic duct
95% of the time
What is it called when acute cholecystitis is caused by something other than gallstones?
Acalculous cholecystitis
When can acalculous cholecystitis occur?
When patients have total parenteral nutrition or long periods of fasting e.g. ICU
Gallbladder not stimulated by food to empty causing a pressure build-up
How does acute cholecystitis present?
RUQ pain radiating to right shoulder
Fever
Nausea
Vomiting
Tachycardia and tachypnoea
Murphy’s sign
Raised inflammatory markers +WBCs
What is the first step in suspected acute cholecystitis?
Abdominal ultrasound scan
MRCP if nothing can be seen
What is present on an abdominal ultrasound scan with acute cholecystitis?
- Thickened gallbladder wall
- Stones or sludge in gallbladder
- Fluid around the gallbladder
How is acute cholecystitis managed?
Nil by mouth
IV fluids
IV Co-amoxiclav +/- metronidazole
Antiemetics
NG tube
ERCP
Cholecystectomy within 72 hours
Why might a cholecystectomy be delayed for 6-8 weeks?
Allow inflammation to settle
What are the complications of acute cholecystitis?
Sepsis
Gallbladder empyema
Gangrenous gallbladder
Perforation
How is gallbladder empyema managed?
IV antibiotics
Cholecystectomy or cholecystostomy (to drain infected contents)
