Cholecystitis Flashcards
What is the official term for the neck of the gall bladder where stones often lodge?
Hartmann’s pouch
What is the main difference in presentation between biliary colic (gall bladder squeezing on stones) and cholecystitis
Biliary colic pain lasts <2hrs
Cholecystitis pain lasts throughout the day + fever + vomiting
Where does cholecystitis pain radiate to?
Back and right scapula
What is the main difference in presentation between colic and peritonism?
Peritonism patients want to stay rigid
colic patients can’t get comfortable, keep moving
What is murphy’s sign?
And how do you know a pt is showing true murphy’s?
2 fingers over gall bladder, ask pt to breath in = pain and breath catch.
Murphy’s only +ve if this sign is -ve on the left
What is phlegmon?
Mass of adherent omentum and bowel that may be palpable. SIgn of cholecystitis
What is Boas’ sign?
Hyperaesthesia below the right scapula. Sign of cholecystitis
In cholecystitis, what would you expect to find on a urine dip?
Raised bilirubin
Raised urobilinogen
Over what size would you consider bile ducts to be dilated on ultrasound?
> 6mm
Gall bladder wall oedema on ultrasound suggests?
Inflammation
If dilated ducts seen on US, what investigation is required?
MRCP (magnetic resonance cholangiopancreatoraphy)
What is the antibiotic therapy for cholecystitis
cef and met
What percentage of episodes of acute cholecystitis settle after over 24-48hrs with conservative therapy?
80-90%
What are the conservative therapies for acute cholecystitis (4)
NBM
Fluid resus
Analgesia
Abx
What are the signs of a gall bladder empyema (2) and how would you manage it?
High fever
RUQ mass
Percutaneous drainage: cholecystectomy
Which hormone stimulates gall bladder contractions
CCK
What is the phrase used to describe the appearance of gallstones on an AXR?
Porcelain gallbladder
What is the name of a gall bladder blocked by a stone and swollen with secretions?
Mucocele
How would you differentiate between a presentation of cholecystitis and ascending cholangitis?
Ascending cholangitis causes high grade fever 39< and rigors
What is the colloquial name of ascending cholangitis
The silent assassin
What are the features of charcot’s triad, and what does it describe?
Fever, jaundice, RUQ pain
Ascending cholangitis
What conditions (3) make a person more likely to have gallstone ileus?
Dementia
Learning difficulties
Paralysis
Caused by chronic cholecystitis that hasn’t been treated, fistula forms between gall bladder and duodenum for gallstone to pass through and block ileo-cecal valve
