Cholecystitis Flashcards
What are the risk factors for cholecystitis?
Gallstones
- Fair, fat, female, fertile, forties
Crohn’s disease
Diabetes
Systemic illness
Dehydration
What are the symptoms of cholecystitis?
No jaundice
RUQ pain
Referred right shoulder tip pain
Fever
Nausea and vomiting
Murphy’s sign
Abdominal mass
What is Murphy’s sign?
Palpating the RUQ whilst the patient breathes in deeply causes pain, and the cessation of inspiration
Where may gallstones become impacted, causing cholecystitis?
The neck of the gallbladder or the cystic duct
What are the initial investigations in the diagnosis of cholecystitis?
Abdominal ultrasound - first line
FBC
LFTs - derangement suggests obstructing CBD stone
U&Es - AKI secondary to infection
Inflammatory markers
What results are seen on abdominal ultrasound in cholecystitis?
Thickened gallbladder wall (>3mm)
Distended gallbladder
Stones or sludge in the gallbladder
Pericholecystic fluid
When is an MRCP used?
When there is a suspected CBD stone, in cases where ultrasound has not detected gallstones but a dilated CBD and/or LFTs are abnormal
What is the first line management of cholecystitis?
Conservative management:
IV fluids
Analgesia
IV broad spectrum antibiotics
What procedures can be performed in the management of cholecystitis?
ERCP - can be used to remove stones trapped in the CBD
Cholecystectomy
What are the complications of cholecystitis?
Sepsis
Gallbladder empyema
Gangrenous gallbladder
Perforation
