Cholecystitis

Question 1

def

Answer 1

gallbladder inflammation
major complication of cholelithiasis or gallstones
in most causes it is caused by complete cystic duct obstruction

Question 2

aetiology

Answer 2

• gallstones in 90% of patients
• helminthic infection in asia, southern africa

bacterial infection is a secondary feature and not an initiating event

Question 3

what is acalculous acute cholecystitis

Answer 3

acute inflammation of the gallbladder in the absence of gallstones

Question 4

what are the risk factors for acalculous acute cholecystitis

Answer 4

starvation

total parenteral nutrition

Question 5

epi

Answer 5

more common in females

majority of patients with gallstones are asymptomatic, about 1-2% become symptomatic each year

Question 6

epi of acalculous cholecystitis

Answer 6

3 times more common in females before 50

1.5 times more common in females after 50

Question 7

risk factors

Answer 7

gallstones
biliary tract disease (gallbladder dysmotility, gallbladder ischaemia)
severe illness inc trauma & burns increases risk of acalculous acute cholecystitis
total parenteral nutrition (causes gallbladder stasis, causing accumulation of toxic agents which results in gallbladder damage)

Question 8

history & examination

Answer 8

1 previous episode of biliary pain
2 RUQ pain
3 positive murphys sign
4 distended, tender gallbladder
5 right shoulder pain (scapular)

Question 9

what is murphys sign

Answer 9

palpation on the right subcostal region reveals tenderness, during inspiration tenderness becomes suddenly worse as it causes gallbladder to hit the hand
inspiration will stop

Question 10

investigations

Answer 10

1 bloods
-FBC (raised WCC)
-CRP (raised)
-LFTs (elevated alkphos, GGT, bilirubin)
2 RUQ USS

Question 11

what is a cholestatic picture

Answer 11

elevated alkphos, GGT, bilirubin

indicates decreased bile flow, either due to impaired secretion or obstruction

Question 12

management

Answer 12

MEDICAL
-npo (nil per oral)
-IV fluids
-antibiotics
-analgesia (NSAIDS)
-monitoring
SURGICAL
-cholecystectomy
-percutaneous cholecystostomy tube (if medical treatment fails & poor surgical candidates)

Question 13

why are NSAIDs indicated for cholecystitis

Answer 13

e.g. diclofenac

for their anti-inflammatory effect & inhibition of prostaglandin release from the gallbladder wall

Question 14

complications

Answer 14

perforation
suppurative cholecsystitis
gangrenous cholecystitis

Question 15

what is suppurative cholecystitis

Answer 15

suppuration is the process of pus forming

therefore inflammation of the gallbladder with formation of pus

Question 16

what is gangrenous cholecystitis

Answer 16

type of necrosis by insufficient blood supply

Question 17

prognosis

Answer 17

removal of gallbladder & gallstones will reduce risk of cholecsystitis
if gallbladder perforates 30% mortality risk

untreated acute acalculous cholecystitis 50% mortality risk