Acute cholecystitis Flashcards
What is acute cholecystitis?
Acute cholecystitis describes inflammation of the gallbladder.
What is the primary cause of acute cholecystitis?
It develops secondary to gallstones in 90% of patients.
What are the remaining 10% of cases of acute cholecystitis called?
They are referred to as acalculous cholecystitis.
In which patients is acalculous cholecystitis typically seen?
It is typically seen in hospitalized and severely ill patients.
What are the multifactorial causes of acute cholecystitis?
Gallbladder stasis, hypoperfusion, and infection.
What infections can cause acute cholecystitis in immunosuppressed patients?
It may develop secondary to Cryptosporidium or cytomegalovirus.
What are the associated risks of acute cholecystitis?
It is associated with high morbidity and mortality rates.
What are the common features of acute cholecystitis?
Right upper quadrant pain, fever, and signs of systemic upset.
What is Murphy’s sign?
Inspiratory arrest upon palpation of the right upper quadrant.
What do liver function tests typically show in acute cholecystitis?
Liver function tests are typically normal.
What may deranged LFTs indicate in acute cholecystitis?
They may indicate Mirizzi syndrome, where a gallstone impacts the distal cystic duct.
What is the first-line investigation for acute cholecystitis?
Ultrasound is the first-line investigation of choice.
What is cholescintigraphy (HIDA scan)?
It may be used if the diagnosis remains unclear, involving technetium-labelled HIDA injected IV.
What happens to the gallbladder in acute cholecystitis during a HIDA scan?
The gallbladder will not be visualized due to cystic duct obstruction.
What is the initial treatment for acute cholecystitis?
Intravenous antibiotics and cholecystectomy.
What does NICE recommend for cholecystectomy timing?
Early laparoscopic cholecystectomy within 1 week of diagnosis.
What was the previous recommendation for surgery timing in acute cholecystitis?
Surgery was previously delayed for several weeks until inflammation subsided.
What is recommended for pregnant women with acute cholecystitis?
They should proceed to early laparoscopic cholecystectomy to reduce maternal-fetal complications.
