Cholecystitis Flashcards
1
Q
What causes cholecystitis?
A
•cholelithiasis (gallstones) block cystic duct.
2
Q
What are symptoms of cholecystitis?
A
- pain in the upper right quadrant – consistent, several hours, may radiate to back
- tenderness in the right upper quadrant (murphy’s sign)
- signs and symptoms of inflammation (fever, ESR, CRP, WBC)
- palpable mass
- fever/chills
- nausea
- right shoulder pain
- anorexia.
3
Q
What are risk factors of cholecystitis?
A
- Gallstones
- Previous episode of biliary pain
- Severe illness (Gallbladder dysmotility or ischaemia)
- Physical activity level
- Ceftriaxone (Causes precipitation of calcium salts into bile)
- Ciclosporin (Can decrease bile acid secretion).
4
Q
What are the 1st Ix for cholecystitis to order?
A
- IF SEPSIS considered - CT or MRI of the abdomen (thickening of wall, ^fatty tissue, gas in gallbladder wall)
- NO SEPSIS – abdominal US
- FBC - ^WBC
- ^CRP
- Suggest probems w/ liver/pancreas:
- BR – if raised, CBD stones, cholestasis in adjacent liver tissue
- LFTs - ^ALP, AT, GGT
- Serum amylase/lipase to exclude pancreatitis
- Blood/bile cultures.
5
Q
What extra Ix can we consider for cholecystitis?
A
- MRCP (if US shows no CBD stones but LFTs abnormal/BD dilated)
- EUS (if above and MRCP = no stones).
6
Q
What is Tx for cholecystitis with organ dysfunction?
A
- transfer the patient to the intensive care unit to monitor and treat the organ dysfunction
- fluid resuscitation, along with analgesia and antibiotics (if infection is suspected), prior to surgery
- laparoscopic cholecystectomy
- percutaneous cholecystostomy patients if unfit for general anaesthesia and surgery.
7
Q
What is Tx for cholecystitis without organ dysfunction?
A
- Analgesia (paracetamol/NSAIDS)
- Fluid resus
- Abx
- Laparoscopic or percutaneous cholecystostomy
8
Q
What is the prognosis of cholecystitis like?
A
- Remove stones when biliary pain starts
- If gallbladder perforates, 30% mortality
- Untreated acute acalculous cholecystitis is life-threatening – 50% mortality
