cholangitis vs cholecystitis

Question 1

What is cholecystitis?

Answer 1

Acute cholecystitis refers to the acute inflammation of the gallbladder, with 90% of cases being secondary to gallstones

Question 1

What is cholangitis?

Answer 1

Acute cholangitis, or ascending cholangitis, refers to an acute bacterial infection of the biliary tree and is one of the most serious complication of gallstones

Question 2

What are the clinical features of cholecystitis?

Answer 2

1. Constant RUQ pain
2. May radiate to the epigastrium and/or right shoulder and interscapular region
3. Pain is worse on deep inspiration
4. Murphy’s positive
5. Usually systemically unwell

Question 3

What are the clinical features of cholangitis?

Answer 3

Charcot’s triad of RUQ pain, fever and jaundice
Systemically very unwell (fever, hypotension, tachycardia, tachypnoea, rigours)

Question 4

What is the main difference in presentation of cholecystitis and cholangitis?

Answer 4

Jaundice is present in cholangitis

Question 5

What blood test would you expect in a patient with cholecystitis?

Answer 5

↑ WCC/CRP
Liver function tests may be normal or may show a raised bilirubin, ALP, ALT and Gamma-GT

Question 6

What blood test would you expect in a patient with cholangitis?

Answer 6

↑ WCC/CRP

↑ ALP and bilirubin

Gamma-GT, AST and ALT may also be mildly ↑

Question 7

How would you manage cholecystitis?

Answer 7

Consider hospital admission for oral/IV antibiotics
Laparoscopic cholecystectomy

Question 8

How would you manage cholangitis?

Answer 8

Sepsis six, broad-spectrum antibiotics
ERCP