Cholecystisis

Question 1

Define cholecystisis

Answer 1

acute gallbladder inflammation, and one of the major complications of cholelithiasis or gallstones

Question 2

What are the causes/risk factors of cholecystisis?

Answer 2

• calculous cholecystitis (gallstones)
• acalculous cholecystitis occurs in the rest of the cases, in the absence of gallstones: 
- Starvation 
- TPN 
- Immobility 
- Narcotic analgesia

Question 3

What are the symptoms of cholecystisis?

Answer 3

• History of gallstones and biliary colic
• Fever
• Prolonged RUQ pain, referred to the right scapula/ back due to diaphragmatic irritation
• Systemically unwell –septic /in shock

Question 4

What are the signs of cholecystisis?

Answer 4

• Tachycardia
• Pyrexia
• RUQ or epigastric tenderness
• There may be guarding and rebound tenderness due to peritonism
• Murphy’s sign is elicited by placing a hand at the costal margin in the RUQ and asking the patient to breathe deeply, the patient stops breathing as the inflamed gallbladder descends and contacts the palpating fingers
• A phlegmon may be palpable: RUQ mass of inflamed adherent omentum and bowel.

Question 5

What investigations are carried out for cholecystisis?

Answer 5

• FBC - eucocytosis and Neutrophilia
• LFTs - obstructive picture: Elevated ALP, GGT and BR.
• CRP - elevated
• USS Abdomen - distended gallbladder, thickened gallbladder wall, gallstones, pericholecystic fluid ans positive sonographic Murphy’s sign
• HIDA (Hepatic Iminodiacetic Acid/ Cholescintigraphy) - directly shows cystic duct obstruction. Used if the diagnosis remains in doubt after ultrasound scanning
• AXR - may show gallstones if radio-opaque
• CT/ MRI - inflammation of the gallbladder and thickening of the gallbladder wall

Question 6

What is the management for cholecystisis?

Answer 6

Conservative and Medical: 
• NBM 
• Analgesia 
• IV Fluids 
• IV Antibiotics e.g. cefuroxime.  

Interventional:
• Laparoscopic cholecystectectomy is the treatment of choice for all patients.
• Open surgery is required if there is GB perforation.
• If elderly or high risk/unsuitable for surgery, consider percutaneous cholecystostomy; cholecystectomy can still be done later.
• Cholecystostomy is also the preferred treatment for acalculous cholecystitis

Question 7

What are the complications of cholecystisis?

Answer 7

• Gallbladder perforation
• Gangrenous cholecystisis
• Complications of gallstones and surgery