Acute Cholecystitis Flashcards
How are gallstones formed? What are the most common types?
a high concentration of cholesterol or calcium bilirubinate in bile
bile becomes supersaturated
the precipitate from solution as microscopic crystals –> sludgy bile
crystals grow + aggregate to form macroscopic stones
ducts can become occluded –> symptoms
cholesterol is most common, then pigmented or mixed
How are cholesterol gallstones formed?
high concentration of cholesterol and phospholipid in bile + stasis of bile
What are some causes of cholecystitis?
from gallstones (obesity, metabolic syndrome, pregnancy, gallbladder stasis, drugs, hereditary, high haem turnover) Crohn's Ileal resection burns parenteral nutrition cirrhosis
How can you differentiate bewteen acute and chronic cholecystitis?
chronic;
intermittent obstruction –> recurrent biliary colic
gallbladder becomes fibrotic and contracted
RUQ tenderness may be present
no fever
acute; severe biliary colic pain lasting >6hrs vomiting \+ve murphy sign low-grade fever
What is the difference between biliary colic and cholecystitis?
biliary colic = pain experienced from obstruction of the biliary system often due to gallstones
cholecystitis = inflammation of gallbladder wall frequently because of prolonged obstruction due to gallstones
acute cholecystitis will present with fever, raised WCC, local peritonism
When is surgery considered an option for gallstones?
symptomatic OR asymptomatic but >2cm the gallbladder is nonfunctional/high risk of carcinoma spinal cord injury sickle cell patients
How can you medically treat gallstones?
Ursodeoxycholic acid (ursodiol) = dissolves gallstones
long term administration –> lowers hepatic cholesterol secretion –> lowers the detergent effect of bile salts –> decreases cholesterol saturation of bile
What surgical options are available to cholecystitis/gallstone patients?
cholecystectomy
cholecystostomy
percutaneous cholecystostomy tube –> poor surgical candidates
Why might you perform an open cholecystectomy rather than laparoscopically?
gallbladder mass
extensive upper abdominal surgery
suspicion of malignancy
late third-trimester pregnancy
Who is typically affected by gallstones?
5-25% of adults in the western world
F>M
What are some risk factors for gallstones?
TPN CMV, cryptosporidium, salmonella typhi overweight hight fat/cholesterol diet low fibre diet rapid weight loss DBM F>M FHx >60yrs cirrhosis pregnancy HRT Statins
5 Fs - Female, Fat, Forty, Fair, Fertile
What are some complications of cholecystitis?
suppurative cholecystitis =
thickened gallbladder wall with WBC infiltration, intra-wall abscesses and necrosis –> perforation
chronic cholecystitis perforation gangrenous bile duct injury due to surgery gallstone ileus
What are the S+S for acute cholecystitis?
RUQ pain --> radiated to right shoulder \+ve Murphy's sign N&V fever local peritonism gallbladder mass
What imaging might you request for suspected acute cholecystitis?
RUQ US - >90% specific
can see pericholecystic fluid, distended and thickened gallbladder, and gallstones
cholescintigraphy
absence of filling gallbladder within 1 hour after administration indicated obstructed bile duct
abdo MRI - pregnancy
How would you manage a patient with acute cholecystitis medically?
NPO
IV fluids + abx
analgesia
BP, HR and UO monitoring
