Cholecystitis Flashcards
Acute cholecystitis refers to?
Inflammation of the gallbladder
What is the most common cause of acute cholecystitis
Gallstones (calculous cholecystitis) either blocking the neck of the gallbladder or the cystic duct
Define Calculous cholecystitis
Acute cholecystitis in the presence of gallstones
Define Acalculous cholecystitis
Acute cholecystitis in the absence of gallstones. They are relatively rare.
What are the two main presenting symptoms of acute cholecystitis
- Constant pain in the right upper quadrant or epigastrium, which may radiate to the right shoulder
- Signs of inflammation e.g. fever, lethargy.
Describe the pain patients experience with acute cholecystitis
Constant pain in the right upper quadrant or epigastrium, which may radiate to the right shoulder
Murphy’s sign is indicative of which condition
Cholecystitis i.e. inflammation of the gallbladder
Name some of the symptoms of acute cholecystitis
- Right upper quadrant or epigastric pain
- Nausea and/or vomiting
- Fevers
- Lethargy
Name some of the signs of acute cholecystitis
- Murphy’s sign
- RUQ / epigastric tenderness
- RUQ / epigastric guarding
- Pyrexia
- Tachycardia (fast heart rate)
- Tachypnoea (raised respiratory rate)
- Hypotension – suggestive of sepsis
- Guarding – suggestive of gallbladder perforation
Define Murphy’s sign
Acute Pain in the RUQ during inspiration
Describe the mechanism behind the pain associated with Murphy’s sign
Pain is present as the gallbladder moves downwards during inspiration and comes in contact with the pressure and thus this stimulates the inflamed gallbladder
What is the gold standard investigation for acute cholecystitis
Trans-abdominal ultrasound scan
CRP and WCC will be ____ in acute cholecystitis:
a) raised
b) lowered
c) normal
a) raised
Which LFT blood test is likely to be raised in acute cholecystitis
ALP
A raised ALP is indicative of?
Ductal occlusion
What is the 1st line imaging modality for acute cholecystitis
Ultrasound
If results from US scans are inconclusive, further imaging options are available
What is the gold standard imaging modality for gallstones
Magnetic resonance cholangiopancreatography (MRCP)
What are the 3 signs of acute cholecystitis on ultrasound
- Thickened gallbladder wall
- Stones or sludge in gallbladder
- Fluid around the gallbladder
What is the aim of management for acute cholecystitis
Aim of management is to treat the infection and symptoms and prevent recurrence (with laparoscopic cholecystectomy)
How would symptoms be managed in acute cholecystitis
- IV antibiotics – as per local guidelines
- Fluids – resuscitation and maintenance fluids are required.
- Analgesia – + antiemetics
-
Nil by mouth – in preparation for surgery
- NG tube – if required for vomiting
What is the difference between hot and interval laparoscopic cholecystectomy:
‘Hot’ laparoscopic cholecystectomy: surgery is arranged within 72 hours (or at some centres up to one week) of the onset of symptoms. Most common
Interval laparoscopic cholecystectomy: removal of a diseased gallbladder after drainage for acute infection
Name some of the Complications of cholecystectomy
- Bleeding, infection, pain, and scars
- Damage to the bile duct including leakage and strictures
- Stones left in the bile duct
- Damage to the bowel, blood vessels or other organs
- Anaesthetic risks
- Venous thromboembolism (deep vein thrombosis or pulmonary embolism)
- Post-cholecystectomy syndrome
For those not fit for surgery and not responding to antibiotics what can be performed to drain the infection
Percutaneous cholecystostomy
Once recovered, patients are often discharged with this drain in situ until definitive management can be arranged.
Any patient readmitted with RUQ pain post-cholecystectomy is it important to exclude?
A retained CBD stone post-operatively
