Acute Cholecystitis

Question 1

What is Acute Cholecystisis?

Answer 1

Acute Cholecystisis is inflammation of the gall bladder usually caused by a gall stone blocking the cystic duct.
Accounts for 30% of patients attending ED with abdominal pain.
In most cases it is resolved by itself often following a fever.

Question 2

Acute Cholecystisis pain symptoms ?

Answer 2

• Mid-epigastric pain to begin with
• A sharp pain the right upper quadrant of the abdomen.
• May experience right shoulder tip pain
• Pleuritic pain
• Pain intensifies on palpation of right upper quadrant

Question 3

Acute Cholecystisis S&S?

Answer 3

• Nausea and Vomiting
• Temp > 38
• History of fat intolerance

Question 4

What occurs following the obstruction of the cystic duct by a gall stone?

Answer 4

• Stone block cystic duct causing mid-epigastric pain
• CCK triggers gall bladder to squeeze out bile
• Gall bladder distension occurs
• Bile stasis irritates mucosa causing secretion of inflammatory enzymes causing inflammation and distension (At this point pain moves to Right Upper Quadrant)
• Bacteria growth leading to peritonitis
• Presence of bacteria in mucosa triggers immune system = fever
• If the stone does not auto remove then venous compression = ischemia = necrosis = perforation which is characterised by sharp pain = sepsis

Question 5

Discuss jaundice with reference to acute cholecystitis?

Answer 5

• If the blockage is further down from cystic duct in bile duct then this results in bile backing up into the Liver
• Bile eventually pushes through cell junctions of bile duct into bloodstream
• Presence of conjugated bilirubin in blood = jaundice

Question 6

Acute Cholesterolcyctisis A&M?

Answer 6

• Be aware of life threatening and ME conditions.
• For indigestion type pain consider cardiac
• ABCDE
• Full abdo exam in supine position
• If childbearing age female consider additional causes
• Full history
• Think Sepsis?
• O2, analgesic, fluids