Cholecystitis (1)

Question 1

What occurs in Acute Cholecystitis?

What is Acute Acalculous Cholecystitis?
→ What causes it?
→ Why does it occur in major trauma/burns?

What is Chronic Cholecystitis?
→ How is the gallbladder affected?

Answer 1

➊ Stone blocks neck of gallbladder or cystic duct for a long period of time, rubbing against and damaging the mucosal lining, causing inflammation

➋ Acute Cholecystitis w/o gallstones
→ Ischaemia
→ Cystic artery has no collateral circulation, therefore no way to stop ischaemia if it became less perfused

➌ Recurrent episodes of biliary colic and acute cholecystitis, leading to chronic inflammation with fibrotic scars
→ Makes it thicken and shrink

Question 2

How does it present?

Which investigations are done?

How is it managed?

Answer 2

➊ • RUQ/Eepigastric pain (radiating to right shoulder tip if diaphragm is irritated)
• Fever
• N+V
• Murphy’s +ve

➋ • USS - Thickened gallbladder, Pericholecystic fluid
• MRCP

➌ • Supportive with NBM, IVF, Analgesia, Abx
• Cholecystectomy
• Cholecystostomy to drain gallbladder if acutely unwell, with a plan for a delayed cholecystectomy