Acute Cholecystitis

Question 0

Mirizzi’s syndrome?

Answer 0

Gallstone impacts on the cystic duct or neck of GB.

Compresses common bile duct and causes obstructive jaundice.

Question 1

What does it present with?

Answer 1

RUQ pain
Fever low grade
N+V 
Abdominal distension 
Jaundice

Question 2

Radiological imaging for cholecystitis?

Answer 2

US for stones and gall bladder inflammation

• probe tenderness over GB (sonographic murphys sign)
• distended GB
• thickened wall
• pericholecystic fluid
• dilation of bile ducts

Question 3

Rx of acute cholecystitis?

Answer 3

Stabilise

• immediate mx
• give vitamin k (why?)

Surgery

• emergency cholecystectomy
• early elective cholecystectomy

Palliative for pts unfit for surgery
- percutaneous cholecystostomy to drain GB

Question 4

Complications of surgery?

Answer 4

Haemorrhage
Anaesthestetic risks
Failure of surgery
Infection 
Damage to local structures 
- CBD
- bowel injury bile leak

Question 5

Complications of cholecystitis?

Answer 5

Intraluminal

• mucocoele (mucus with GB)
• empyema (pus within GB)

GB wall

• perforation
• emphesymatous cholecystitis: gas in GB wall or pericholecystic fluid

Extra luminal

• acute pancreatitis
• Mirizzi’s syndrome
• choledolithiasis/cholangitis