Cholecystitis

Question 1

Pathophysiology

Answer 1

Secondary to gallstones in 90% patients

10% acalculous cholecystitis

Question 2

Acalculous cholecystitis

Answer 2

Typically hospitalised and severely ill patients

Multifactorial pathophysiology: gallbladder stasis, hypoperfusion, infection

In immunocompromised patients it may be secondary to Cryptosporidum or CMV

Associated with high morbidity and mortality rates

Question 3

Presentation

Answer 3

RUQ pain radiates to right shoulder

Fever and systemic upset

Nausea and vomiting

Murphy’s sign

Question 4

Murphy’s sign

Answer 4

Place hand in RUQ and apply pressure

Ask patient to take deep breath in

Gallbladder moves down during inspiration and come into contact with hand

Stimulation of inflamed gallbladder results in acute pain and sudden stopping of inspiration

Question 5

Imaging

Answer 5

Abdo US
- thickened gallbladder
- stones or sludge in gallbladder
- fluid around gallbladder

MRCP

Question 6

LFTs

Answer 6

Typically normal

Deranged LFTs may indicate Mrizzi syndrome

Question 7

Management

Answer 7

IV antibiotics

IV fluids

NBM

NG tube if required for vomiting

ERCP or cholecystectomy

Question 8

Complications

Answer 8

Sepsis

Gallbladder empyema

Gangrenous gallbladder

Perforation

Question 9

Gallbladder empyema

Answer 9

Infected tissue and pus collecting in the gallbladder

Management with IV antibiotics

Cholecystectomy or cholecystostomy