Acute cholecystitis

Question 1

What is it and pathophysiology

Answer 1

-inflammation of gall bladder, usually due to gallstone blocking cystic duct and the bladder distending
Pathophysiology
-gallstones form (hardened collection of bile)
-lodges in duct and blocks flow of bile
-gall bladder inflames and distends
-oedema of gall bladder or cystic duct
-oedema further obstructs bile and irritates
-cells become ischaemic and then infarct as the organ distends and presses on vessels, impeding blood flow

Question 2

Signs and symptoms

Answer 2

-RUQ pain
-worse after eating meals high in fat
-nausea and vomiting
-low grade fever
-murphy’s sign- ask breathe out, place fingers under ribs, on inspiration, liver and gallbladder move onto fingers causing pain

Question 3

Risk factors

Answer 3

-middle age
-obesity
-high cholesterol
-high oestrogen (contraceptives, pregnancy, HRT= hormone replacement therapy)
-diabetes
-liver disease
-pancreatitis

Question 4

Differntial diagnosis

Answer 4

-duodenal ulcer (stomach)
-hepatitis
-appendicitis
-pneumonia

Question 5

Treatment

Answer 5

Same as appendicitis
Pain relief
-paracetamol, morphine, entonox (not if obstruction)
Anti emetic
-metoclopromide (not if obstruction)
-ondansetron
Pathway
-transfer to hospital for blood test, ultrasound, cholecystectomy, catheter into bile duct, removal stones, dissolution of stones