Cholecystitis

Question 1

What is Cholecystitis?

Answer 1

Cholecystitis is inflammation of your gallbladder.

Question 2

What is the gallbladder and its function?

Answer 2

Your gallbladder is the sac just under your liver where your body stores bile. Bile is a digestive fluid that helps break down fats in food.

Question 3

What is the cystic duct?

Answer 3

The cystic duct is the tube that takes bile from the gallbladder to the intestine.

Question 4

What is the most common cause of cholecystitis?

Answer 4

Gallstones

Question 5

How does gallstones cause cholecystitis?

Answer 5

Gallstones are solid material that can form in your gallbladder. You can get an attack of cholecystitis when a gallstone blocks your cystic duct. The cystic duct is the tube that takes bile from the gallbladder to the intestine. When the duct is blocked, fluid can’t leave your gallbladder. The fluid irritates your gallbladder and makes it swell up and hurt
The obstruction causes an increase in mucus secretions from the gallbladder, which causes gallbladder distension, and may affect the blood supply to the gallbladder.

Question 6

What is the name given to cases of cholecystitis not caused by gallstones?

Answer 6

acalculous cholecystitis

Question 7

Name the most common site for gallstones to get stuck

Answer 7

Hartmann’s pouch (mucosal fold in the neck of the gallbladder)

Question 8

Are men or women more at risk of gallstones?

Answer 8

women

Question 9

Name the three S’s that trigger the formation of gallstones:

Answer 9

1) Supersaturation
2) Stasis
3) Sepsis

Question 10

Describe how supersaturation can form gallstones:

Answer 10

increased concentration of a solute increases the likelihood of precipitation
Can be caused by dehydration

Question 11

Give two causes of bile stasis:

Answer 11

1) mechanical obstruction (tumours, stents, strictures)
2) impairment of gallbladder emptying

Question 12

Why are females at greater risk of gallstones?

Answer 12

oestrogen and progesterone impair gallbladder emptying

Question 13

Describe the natural history of a cholecystitis presentation:

Answer 13

1) it begins as an attack of biliary colic
2) as the parietal peritoneum around the gallbladder becomes inflamed, the pain becomes sharper and more localised

Question 14

Why does cholecystitis pain radiate to the right shoulder?

Answer 14

the local inflammatory process also irritates the phrenic nerve

Question 15

List 4 presentations associated with cholecystis:

Answer 15

1) biliary colic
2) fever
3) vomiting
4) radiating pain to shoulder or chest

Question 16

Give 3 examination findings associated with cholecystitis:

Answer 16

1) right upper quadrant tenderness and sometimes a mass
2) guarding
3) Murphy’s sign

Question 17

What is Murphy’s sign?

Answer 17

when the patient takes a deep breath in, their tender inflamed gallbladder bumps into the examiner’s hand, causing them to jump or flinch

Question 18

What liver enzyme is raised in cholecystitis?

Answer 18

ALP

Question 19

What imaging technique is used to view the gallbladder in cholecystitis?

Answer 19

ultrasound

Question 20

Give 4 ultrasound findings associated with cholecystitis:

Answer 20

1) thick walled gallbladder (>3mm)
2) impacted gallstones
3) localised oedema
4) pericholecystic fluid

Question 21

Give 4 management strategies used on admission for cholecystitis:

Answer 21

1) nil by mouth
2) IV fluids
3) antibiotics
4) NG tube (if required for vomiting)

Question 22

What antibiotics are usually given in cholecystitis?

Answer 22

Cefuroxime – 1.5mg/8h IV
Metronidazole – add if patient is particularly ill

Question 23

What is the most common treatment for cholecystitis?

Answer 23

cholecystectomy

Question 24

What technique can be used to remove gallstones trapped in the common bile duct?

Answer 24

endoscopic retrograde cholangio-pancreatography

Question 25

Give 4 complications of cholecystitis:

Answer 25

1) sepsis
2) gallbladder empyema
3) gangrenous gallbladder
4) perforation

Question 26

Give 3 causes of acalculous cholecystitis:

Answer 26

1) chronic inflammation secondary to backing up of pancreatic enzymes in the biliary tree
2) bacterial and viral infections
3) necroinflammation of the gallbladder (often occurs after major trauma or surgery)

Question 27

What symptoms are experienced in chronic cholecystitis?

Answer 27

Vague abdominal symptoms: Nausea, pain, distension, flatulence, fat intolerance, IB