Cholecystitis Flashcards
What is the pathophysiology of acute cholecystitis?
Stone impacted in Hartmann’s pouch → inflammation
Some due to DM, burns or sepsis
What are the sequelae of acute cholecystitis?
Resolution ± recurrence
Gangrene and rarely perforation
Chronic cholecystitis
Empyema
What is the presentation of acute cholecystitis?
RUQ pain - continuous, can radiate to scapula & epigastrum
Fever
Vomiting
Empyema/Perforation are signs of deterioration
What is Murphy’s sign?
2 fingers over the gallbladder and ask pt. to breath in → pain + catch breath.
What would be seen in the urine of a patient with acute cholecystitis?
Bilirubin
Urobilinogen
What is the management of acute cholecystitis?
NBM
Fluids
Analgesia
Surgery once inflammation resolved
What investigations can be performed on a patient with acute cholecystitis?
FBC (Increased WCC), U+Es (Dehydration), G+S, Clotting, CRP, Amylase
AXR
USS - ducts dialted >6mm, oedema in GB wall
MRCP if dilated ducts seen on US
How does an empyema differ in presentation to acute cholecystitis?
RUQ pain, RUQ MASS, fever
Treat with cholecystostomy
What are the symptoms for chronic cholecystitis?
Flatulence Dyspepsia Burping Distension/bloating Nausea *Exacerbated by fatty foods - cholecystokinin release from GB - contraction*
What can be seen on investigation of chronic cholecystitis?
AXR - porcelain GB
USS - stones, fibrotic, shrunken gallbladder
MRCP
What is the management of chronic cholecystitis?
ERCP
Cholecystectomy
Can use bile salts as conservative but not very effective
What is a gall bladder Mucocele?
Stone blocks the neck of the gallbladder, but content remains sterile
Can cause a very large palpable mass
If becomes infected called empyema
What would be seen on x ray for gallbladder carcinoma?
Porcelain GB due to calcification
Associated with gallstones + GB polyps
Rare
What is Mirizzi’s Syndrome?
Large stone in GB presses on the common hepatic duct causing obstructive jaundice
Stone may errode through into the ducts
