Cholecystitis Flashcards
What is acute cholecystitis?
major complication of cholelithiasis (i.e., gallstones)
symptomatic gallstones are common before developing cholecystitis
How do patients with acute cholecystitis usually present?
Pain and localised tenderness, with/without guarding in RUQ
Evidence of systemic inflammation - fever, elevated WCC, raised CRP
Anorexia
What is the definitive initial test?
USS
MRCP can be used
What is the general treatment for Acute cholysitis?
ABs
Analgesia (IM Diclofenac)
Fluid resus
Early cholecystectomy if needed
Define acute cholecystitis
Acute gallbladder inflammation
Develops in 10% of patients with symptomatic gallstones
What is the caused of acute cholecystitis in 90% of cases?
Complete cystic duct obstruction
Usually due to impacted gallstones in gallbladder neck
What might be palpable in acute cholecystitis?
Distended, tender gallbladder
If suspected cancer, 2ww USS to assess for gallbladder cancer
What are some risk factors for acute cholecystitis?
Gallstones Previous episode of biliary pain Severe illness Physical inactivity Ceftriaxone Ciclosporin Low fibre intake
Where might RUQ pain refer to in acute cholecystitis?
Right shoulder pain
Due to diaphragmatic irritation
What are first line investigations for acute cholecystitis?
FBC - high WCC in cholecystitis and cholangitis
LFT - high ALP + GGT in ascending cholangitis
Blood cultures
Amylase (exclude pancreatitis)
Urinanalysis, CXR and ECG to exclude other causes
Ultrasound of biliary tree = GOLD STANDARD
When would you order a MRCP in acute cholecystitis?
When USS has not detected common bile duct stones but bile duct is dilated and/or LFTs are abnormal
What are the MRI findings of acute cholecystitis?
Thickening of gallbladder wall > 4mm
Enlargement of gallbladder
Gallstones
Fluid accumulation around gallbladder
Linear shadows in the fatty tissue around the gallbladder
What is first line treatment if there is no associated organ dysfunction?
Analgesia
Consider: fluid resus, Abs
+ Early lap chole
+ post-op managment
What are the signs of acute cholecystitis?
●Tachycardia ●Pyrexia ●Local peritonism ●RUQ pain or epigastric tenderness ●May be guarding and/or rebound tenderness ●Murphy's sign positive
What is Murphy’s sign?
Ask patient to take in and hold a deep breath while palpating the right subcostal area
If pain occurs on inspiration, when the inflamed gallbladder comes into contact with hand
Murphy’s sign is positive.
