CA - Cholecystitis

Question 1

Whats Cholecystitis? (ONLY NEED TO KNOW THIS)

Answer 1

• ACUTE inflammation of gallbladder - below the liver
• associated with abdominal pain, leukocytosis & fever

Question 1

What are the causes of cholecystitis?

Answer 1

Bile flow is impaired.

1. Calculous
   - Gallstone obstructs cystic duct
2. Acalculous
   - gallbladder dysfunction -> impaired emptying without gallstones
   - occurs due to gallbladder ischemia, mainly in critically ill hospitalized clients

Question 2

What are the risk factors for cholecystitis?

Answer 2

1. cholelithiasis/gallstones -> calculous cholecystitis
2. diabetes, obesity
   - Increased cholesterol secretion into bile -> increased risk of gallstone formation
3. medications that decrease gallbladder emptying
   - opioids -> reduced bile flow
4. conditions that cause prolonged fasting dehydration, or immobility,
   - severe illnesses: ischemia/decreased blood flow -> infections
   - fasting + IV feeding -> decreased cholecystokinin release -> decreased gallbladder contractions -> reduced bile flow

Question 3

Whats the difference betwen acute and chronic cholecystitis?

Answer 3

Acute -> chronic if not resolved

Acute cholecystitis
1. bile builds up in the gallbladder -> irritates the mucosa lining -> increases pressure in the gallbladder -> distension & inflammation
2. Over time -> chronic cholecystitis
- chronic inflammation -> body tries to repair the damage -> overtime thickens & stiffens gallbladder = fibrosis -> calcification: gallbladder hardens = porcelain / hard & brittle gallbladder

Question 4

What are the complications of acute and chronic cholecystitis?

Answer 4

1. bile flow blocked -> intestinal bacteria travels up the biliary tract -> infection = ascending cholangitis
2. if the cholecystitis isn’t resolved & increasing pressure in gallbladder -> pushes down on BVs supplying the gallbladder -> ischemic, -> gangrenous tissue death -> perforation -> peritonitis & sepsis

Question 4

What are the symptoms of acute cholecystitis

Answer 4

1. acute, severe, and prolonged abdominal pain in RUQ / epigastric region
2. Boas sign
   the pain can be referred to the right shoulder
3. Positive Murphy sign
   - deeply palpate costal margin at RUQ
   - take a deep breath
   - diaphragm pushes down on their inflamed gallbladder -> sharp pain -> stop breathing in further
4. anorexia, nausea, vomiting,
5. intolerance for fatty foods -> steatorrhea / greasy, foul-smelling stools
6. jaundice
7. fever, chills
8. tachycardia

Question 5

Symptoms of chronic cholecystitis?

Answer 5

1. Episodes of vague & steady abdominal pain, - may be referred to the right shoulder
2. heartburn, nausea and vomiting, intolerance for fatty foods
3. may develop jaundice.

Question 6

Diagnosis of cholecystitis?

Answer 6

1. History and physical assessment,
2. Lab tests
   - leukocytosis
   - elevated LDH, AST, ALT, bilirubin blood levels.
3. Ultrasound
   - confirms diagnosis
   - can detect any gallstones & signs of gallbladder inflammation

Question 7

Whats the treatment of cholecystitis?

Answer 7

Initial treatment of cholecystitis
- supportive measures like intravenous fluids, pain management, and antibiotics

definitive treatment :
- cholecystectomy
- surgical removal of gallbladder
- If surgery can’t be performed, an alternative treatment option is gallbladder drainage, either percutaneously or via ERCP.