Cholecystitis

Question 1

What is cholecystitis and what causes it?

Answer 1

Inflammation of the gallbladder, which is caused by a blockage of the cystic duct preventing the gallbladder from draining

Question 2

What is the commonest cause of cholecystitis?

Answer 2

Gallstones

Question 3

1) What is it called when the dysfunction in gallbladder emptying is caused by something other than gallstones?
2) Name a group of patients that are more likely to suffer from this

Answer 3

1) Acalculous cholecystitis
2) Patients on total parenteral nutrition or having long periods of fasting

Question 4

1) What is the main presenting symptom?
2) Where can this radiate to?
3) Name 3 other features of acute cholecystitis

Answer 4

1) Right upper quadrant pain
2) Right shoulder (Boas’s sign)
3) Fever, nausea, vomiting, tachycardia, tachypnoea , right upper quadrant tenderness, Murphy’s sign and raised inflammatory markers and white blood cells

Question 5

What is Murphy’s sign?

Answer 5

Asking the 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 the examiner’s hand, Murphy’s sign is positive.

Question 6

1) What is the first investigation in acute cholecystitis?
2) What is done if the above doesn’t show anything?

Answer 6

1) Abdominal ultrasound scan
2) Technetium labeled HIDA scan

Question 7

Name 2 aspects of the management of acute cholecystitis

Answer 7

• Nil by mouth
• IV fluids
• Blood cultures
• IV antibiotics (as per local guidelines)
• Involvement of seniors and potentially HDU or ICU
• ERCP, percutaneous drainage – PTC (percutaneous transhepatic cholangiography) or surgical drainage

Question 8

Name 2 complications

Answer 8

• Sepsis
• Gallbladder empyema
• Gangrenous gallbladder
• Perforation

Question 9

What is a gallbladder empyema?

Answer 9

Infected tissue and pus collecting in the gallbladder