Cholecystitis Flashcards
what is the definition of cholecystitis?
Acute cholecystitis is acute gallbladder inflammation, and one of the major complications of cholelithiasis or gallstones.
what is the epidemiology of cholecystitis?
Follows that of gallstones
15% of adults
More common in women
what is the aetiology of cholecystitis?
It develops in up to 10% of patients with symptomatic gallstones. In most cases (90%), it is caused by complete cystic duct obstruction usually due to an impacted gallstone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall. In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing an acalculous cholecystitis.
what are the risk factors for cholecystitis?
Gallstones Severe illness Total parenteral nutrition Diabetes Physical inactivity, low fibre, trauma, burns, hepatic arterial embolism, infections
what is the pathophysiology of cholecystitis?
Fixed obstruction or passage of gallstones into the gallbladder neck or cystic duct causes acute inflammation of the gallbladder wall. The impacted gallstone causes bile to become trapped in the gallbladder, which causes irritation and increases pressure in the gallbladder. Trauma caused by the gallstone stimulates prostaglandin synthesis (PGI2, PGE2), which mediates the inflammatory response. This can result in secondary bacterial infection leading to necrosis and gallbladder perforation.
what are the key presentations of cholecystitis?
pain in upper right quadrant Tenderness in upper right quadrant Signs and symptoms of inflammation Palpable mass Presence of risk factors
what are the signs of cholecysistis?
Signs of inflammation
Palpable mass
Presence of risk factors
Jaundice
what are the symptoms of cholecystitis?
Pain and tenderness in upper right quadrant Symptoms of inflammation Fever Nausea Right shoulder pain Anorexia vomiting
what are the first line and gold standard investigations for cholecystitis?
CT or MRI Abdo ultrasound FBC CRP Bilirubin LFTs Serum lipase Blood cultures / bile cultures
what other tests could be done for cholecystitis?
MRCP
EUS
what are the differential diagnoses for cholecystitis?
Acute cholangitis Chronic cholecystitis Peptic ulcer disease Acute pancreatitis Sickle cell Appendicitis
how is cholecystitis managed?
Severe:
ICU admission, analgesic, fluid resuscitation, antibiotic therapy, percutaneous cholecystostomy
Mild:
Analgesia, fluid resuscitation, antibiotics, early laparoscopic cholecystectomy
how is cholecystitis monitored?
Patients who undergo cholecystectomy should be seen within 2 weeks after discharge from hospital. Patients should be asked about presence or absence of nausea, vomiting, and abdominal pain, as well as their ability to tolerate oral intake. The wound should be reviewed for erythema, discharge, or pain. In addition any signs of jaundice should be noted; if such signs are present, the direct and indirect bilirubin level should be determined and an abdominal ultrasound ordered.
what are the complications of cholecystitis?
Suppurative cholecystitis, bile duct injury from surgery, gallstone ileus, cholecystoenteric fistulas
what is the prognosis of cholecystitis?
Removing the gallbladder and the contained gallstones when biliary pain starts will prevent further biliary attacks and reduce the risk of developing cholecystitis. If the gallbladder perforates, mortality is 30%.
Untreated acute acalculous cholecystitis is life-threatening and is associated with up to 50% mortality
