CHOLECYSTITIS

Question 1

DEFINE

Answer 1

Inflammation of the gallbladder

Question 2

What are the types of stones and their % ?

Answer 2

Mixed Stones (80%)
• Contains cholesterol, calcium bilirubinate, phosphate and protein
• Form due to an imbalance between bile salts, phospholipids, cholesterol,
nucleation factors and gallbladder motility \

Pure Cholesterol Stones (10%)

Pigment Stones (10%)
• Black stones made of calcium bilirubinate
• Form due to increased bilirubin (e.g. due to haemolysis)

Question 3

Explain the risk factors of cholecystitis

Answer 3

o  Age  
o  Female  
o  Fat 
o  Diabetes mellitus  
o  Drugs (OCP, octreotide)  
o  Family history  
o  Ethnicity (Caucasian)  

5 F’s = Fat, Female, Fertile, Forty, Fair

Pigment Stone Risk Factors: haemolytic disorders (e.g. sickle cell anaemia)

Question 4

Summarise the epidemiology of cholecystitis

Answer 4

• Very COMMON
• UK prevalence of gallstone disease = 10%
• 3 x more common in FEMALES
• More common with increasing age

Question 5

Recognise the presenting symptoms of cholecystitis

Answer 5

• Systemically unwell
• Fever
• Prolonged abdominal pain
• Pain may be referred to right shoulder (due to diaphragmatic irritation)

Question 6

Recognise the signs of cholecystitis on physical examination

Answer 6

• Tachycardia
• Pyrexia
• RUQ pain or epigastric tenderness
• May be guarding or rebound tenderness
• Murphy’s sign positive

Question 7

Identify appropriate investigations for cholecystitis

Answer 7

BLOODS
o FBC M high WCC in cholecystitis and cholangitis o LFT M high ALP + GGT in ascending cholangitis
o Blood cultures
o Amylase (exclude pancreatitis)

ULTRASOUND
o Shows gallstones
o Increased thickness of gallbladder wall
o Dilatation of biliary tree

AXR
but only 10% of gallstones are radio-opaque

OTHER IMAGING
exclude differentials (e.g. erect CXR, ERCP)

Question 8

Generate a management plan for cholecystitis

Answer 8

CONSERVATIVE
o If only mild biliary colic -follow a low-fat diet

MEDICAL
o NBM
o IV fluids
o Analgesia
o Anti-emetics
o Antibiotics (if infection is present)
o NOTE: if symptoms persist despite antibiotic treatment, suspect a localised
abscess or empyema, which would require drainage
o If there is an obstruction, urgent biliary drainage by ERCP or via a percutaneous
route is necessary

SURGICAL
o Laparoscopic Cholecystectomy

Question 9

Identify possible complications of cholecystitis for stones WITHIN the gallbladder

Answer 9

o Biliary colic
o Cholecystitis
o Gallbladder empyema
o Gallbladder cancer (RARE)

Question 10

Identify possible complications of cholecystitis for stones OUTSIDE the gallbladder

Answer 10

o  Obstructive jaundice  
o  Pancreatitis  
o  Ascending cholangitis  
o  Cholecystoduodenal fistula  
o  Gallstone ileus  
o  Bouveret syndrome (gallstones cause gastric outlet obstruction)  
 o  Mirizzi syndrome

Question 11

Identify possible complications of cholecystitis post cholecystectomy

Answer 11

o  Bleeding  
o  Infection  
o  Bile leak 
o  Post-cholecystectomy syndrome  
o  Port-site hernia

Question 12

Summarise the prognosis for patients with cholecystectomy

Answer 12

• Gallstones do NOT cause symptoms most of the time

* Surgery offers an excellent chance of cure if they were to become symptomatic