Acute Cholecystitis

Question 1

Pathophysiology

Answer 1

Inflammation of the gall bladder

90% due to gall stones impacted in cystic duct

Question 2

Types of gallstones

Answer 2

Cholesterol stones

Pigment stones - due to bilirubin

Question 3

Presentation

Answer 3

Biliary colic RUQ pain and tenderness
Fever
Nausea and vomiting - if severe

Question 4

Signs

Answer 4

Murphy’s sign - pain when inhaling when RUQ pressed

Guarding

Question 5

Investigations

Answer 5

Abdominal examination 
Obs 
Blood tests - FBC, U+Es, LFTs, CRP 
Abdo USS - first line 
Cholescintigraphy - technetium labelled HIDA

Question 6

Management

Answer 6

Analgesia - morphine and metoclopramide
Fluids - IV
Abx - ceftriaxone + metronidazole
Cholecystectomy - total removal within 1 week of diagnosis ideally within 48 hours

Question 7

Common bacteria

Answer 7

E. Coli

Klebsiella

Question 8

Complications

Answer 8

Gangrene
Perforation
Fistula

Question 9

What to do if complications suspected

Answer 9

Trans abdominal USS or CT

Question 10

Differentials

Answer 10

Biliary colic
Ascending cholangitis
Fitz - Hugh Curtis syndrome

Question 11

Mirizzi syndrome

Answer 11

Gallstone in cystic duct compresses the common hepatic duct

Question 12

Biliary colic risk factors

Answer 12

Fat
Forty
Female
Fertile - Pregnancy

DM
Crohns
Rapid weight loss
Drugs - fibrates

Question 13

Features of biliary colic

Answer 13

Colicky RUQ pain
Worse when eating fatty meal
May radiate to right shoulder
N+V

Question 14

Ix of biliary colic

Answer 14

USS

Question 15

Mx of biliary colic

Answer 15

Elective laparoscopy within 6 weeks