Cholecystitis

Question 1

What is cholecystitis?

Answer 1

Inflammation of the GB associated with gall stones.

Question 2

Which populations is cholecystitis common in?

Answer 2

Young females > males but after age 65, M = F

“Fat, fertile, female, forty”

Question 3

How might cholecystitis present?

Answer 3

Right hypochondrium colicky pain
o May radiate to right shoulder
o Associated with nausea and vomiting

Possible peritonitis (Murphy’s sign positive)

Pyrexia and tachycardia

Question 4

How would you investigate cholecystitis?

Answer 4

Bloods - ↑WCC ↑CRP

LFTs – non-specific - not obstructive because there is no obstruction of hepatic bile outflow

USS abdo – thickening of GB walls with pericystic collections and can visualise stone. Dilatation of biliary tree can indicate obstruction

Question 5

How would you manage cholecystitis?

Answer 5

Conservative – analgesia, antibiotics

Surgery – cholecystectomy

Question 6

What are some possible complications of cholecystitis?

Answer 6

• Mucocele
• Empyema of GB
• Fistula with bowel ‘cholecysto-jejnual fistulae’
• Sepsis