Acute Cholecystitis

Question 1

What is acute cholecystitis?

Answer 1

refers to the inflammation of the gallbladder most commonly occurring due to impacted gallstones.

Question 2

What is calculous and acalculous cholecystitis?

Answer 2

Calculous- inflammation and infection that occurs when a stone becomes impacted in the cystic duct

Acalculous- refers to gallbladder inflammation in the absences of gallstones.

Question 3

What are the risk factors for acalculous cholecystitis?

Answer 3

Diabetes
Age
Recent major surgery (e.g. cardiac surgery)
Myocardial infarction
Sepsis
Major burn
Major trauma
Cancer
Immunocompromised patients
Vasculitis
CKD

Question 4

What signs and symptoms does cholecystitis present with?

Answer 4

Symptoms:
- RUQ/epigastric pain
- N&V
- fevers

Signs:
- RUQ/epigastric tenderness and guarding
- pyrexia
- tachycardia
- hypotension

• Murphy’s sign

Question 5

What investigations would you do to confirm cholecystitis?

Answer 5

• US
• CT abdomen/pelvis
• MRCP
• ERCP
• Urine dip
• Pregnancy test
• FBC
• U&Es
• CRP
• LFTs
• Amylase

Question 6

How is cholecystitis managed?

Answer 6

1) antibiotics- IV augmentin. a Stat dose of an aminoglycoside (eg. Getamicin)
2) Fluids- IV fluids for resuscitation and maintenance
3) Analgesia
4) Gallbladder drainage- some patients may develop gallbladder empyema, often the patient is not suitable for a ‘hot’ laparoscopic cholecystectomy. In these patients, a percutaneous cholecystostomy (drain into the gallbladder placed by interventional radiology) may be more appropriate.
5) Cholecystectomy- ‘Hot’ laparoscopic cholecystectomy, Interval laparoscopic cholecystectomy.

Prior to cholecystectomy, it is key that CBD stones are excluded. If suspected:
1) MRCP +/- ERCP
2) On-table cholangiogram