Cholecystitis

Question 1

What is acute cholecystitis?

Answer 1

• Inflammation of the gallbladder
• Caused by a blockage of the cystic duct, preventing the gallbladder from draining

Question 2

What is the primary cause of acute cholecystitis?

Answer 2

The majority of cases (around 95%) are caused by gallstones (calculous cholecystitis).

Question 3

What is acalculous cholecystitis?

Answer 3

Dysfunction in gallbladder emptying caused by something other than gallstones.

Question 4

In which scenarios can acalculous cholecystitis occur?

Answer 4

It may occur in patients on total parental nutrition or during long periods of fasting, such as in ICU for serious conditions.

Question 5

What is the main presenting symptom of cholecystitis?

Answer 5

Pain in the right upper quadrant (RUQ), which may radiate to the right shoulder.

Question 6

What are other features of acute cholecystitis?

Answer 6

Other features include:
- fever
- nausea, vomiting
- tachycardia, tachypnoea
- right upper quadrant tenderness
- raised inflammatory markers.

Question 7

What is Murphy’s sign?

Answer 7

• Murphy’s sign is suggestive of acute cholecystitis
• Involves applying pressure in the RUQ while the patient takes a deep breath.
• Arrest of inspiration

Question 8

What are the signs of acute cholecystitis on ultrasound?

Answer 8

Signs include:
- thickened gallbladder wall
- stones or sludge in the gallbladder
- fluid around the gallbladder.

Question 9

What imaging is used to visualize the biliary tree in detail?

Answer 9

Magnetic resonance cholangiopancreatography (MRCP) may be used if a common bile duct stone is suspected.

Question 10

What is the initial management for suspected acute cholecystitis?

Answer 10

Initial management includes emergency admission, nil by mouth, IV fluids, antibiotics, and NG tube if required.

Question 11

What procedures can be used to manage stones in the common bile duct?

Answer 11

Endoscopic retrograde cholangio-pancreatography (ERCP) can be used to remove stones trapped in the common bile duct.

Question 12

When is cholecystectomy typically performed?

Answer 12

Cholecystectomy is usually performed during the acute admission, within 72 hours of symptoms.

Question 13

What are some complications of acute cholecystitis?

Answer 13

Complications include:
- sepsis
- gallbladder empyema
- gangrenous gallbladder
- perforation

Question 14

What is gallbladder empyema?

Answer 14

Gallbladder empyema refers to infected tissue and pus collecting in the gallbladder.

Question 15

How is gallbladder empyema managed?

Answer 15

Management involves IV antibiotics and either cholecystectomy or cholecystostomy.