CHOLECYSTITIS Flashcards
What is cholecystitis
inflammation of gallladder
develops secondary to gallstones in 90% of patients
What are key diagnostic factors
RUQ pain and tenderness– may radiate to right shoulder
signs of inflammation –fever
palpable mass
MURPHYS SIGN - inspiratory arrest on palpation of RUQ
What are some other diagnostic factors
nausea
anorexia
What are risk factors
gallstones
severe illness
Total parenteral nutrition – causes gallbladder stasis , biliary sludge and gallstones due to decreased gallbladder emptying
Diabetes
What are the first investigations to order
Abdominal ultrasounds to identify gallstones
- if diagnosis is unclear chlescintigraphy
Can also order an abdominal radiograph which is often performed but rarely adds anything further to the diagnosis
Bloods
- FBC, CRP ,LFT , serum amylase, bilirubin
LFTs are typically normal - if deranged indicates Mirizzi syndrome ( gallstones impact distal cystic duct extrinsically )
What are other investigations to consider
Contrast enhanced CT or MRI - if sepsis suspected
blood cultures if septic
MRCP if ultrasound hasn’t detected common bile duct stones
Endoscopic ultrasound if MRCP doesn’t lead to diagnosis
Management of acute cholecystitis
-analgesia, fluid resuscitation and iV antibiotics
Laparoscopic cholecystostomy within 1 week of diagnosis
Percutaneous cholecystostomy if unfit for surgery but not improving after analgesia and antibiotics
postoperative management
What are some complications of gallstones
small bowel obstruction
gall bladder carcinoma
acute pancreatitis
porcelain gallbladder- inner gallbladder wall becomes encrusted with calcium
mucocele of gallbladder
-overdistended gallbladder filled with mucoid/clear and watery content
ascending cholangitis
What imaging modality is more useful than US in delineation of gallbladder calcification
CT is more useful than ultrasound
What is emphysematous cholecystitis
fulminant variety of acute cholecystitis that has the presence of gas in lumen and wall of gallbladder
How does air in the wall arise in emphysematous cholecystitis
arises as a combination of gallbladder ischaemia and infection with gas forming organisms
What patients are most likely to have emphysematous cholecystitis
diabetic patients
What is the presentation and treatment of emphysematous cholecystitis
symptoms and signs are initially minor but mortality is very high
cholecystectomy is the treatment
