Cholecystitis Flashcards
Define
Inflammation of gall bladder
What causes it?
Blockage of gall bladder due to stone/sludge in gall bladder neck
Difference between cholecystitis and biliary colic?
In biliary colic there is no inflammation, just the stones causing the pain in RUQ
Presentation? (3) CHARCOT’S TRIAD
Fever because of inflammation
RUQ pain referred to right shoulder and epigastrium due to diaphragmatic irritation
JAUNDICE
Signs on PE (5)
RUQ pain Rebound tenderness Guarding due to pain Murphy's sign>> when palpating for gall bladder in RUQ and get pt to breathe in, the pt stops to catch breath because it's too painful Increased temperature
When is the murphy’s sign considered positive?
When there is no problem when doing it on the LUQ
App Ix? (5)
FBC» raised wcc
Other bloods» raised crp, LFTs, clotting
Urine= positive for bilirubin and urobilogen
Imaging= AXR» porcelain gallbladder
AUSS» inflamed GB, dilated ducts, acoustic shadow
CXR» check for GI perforation by seeing air under diaphragm
Special= MRCP once you have seen dilated ducts on USS
Mx? medical and surgical
Medical» NBM, IV fluids, Analgesia, Abx, anti-emetics
Surgical» laparoscopic cholecystectomy
What is Charcot’s triad used to diagnose?
acute cholecystitis
What are the three factors in Charcot’s triad of acute cholecystitis?
jaundice, RUQ pain, fever (w, rigours)
what would you expect to be high in blood test for acute cholecystitis?
WCC, CRP, Serum amylase, ALP, bilirubin
How much is the patient allowed to eat during treatment for acute cholecystitis?
nil by mouth
What abx used for acute cholecystitis mx?
Cefuroxime and metronidazole
what causes acute cholecystitis?
gallstone obstruction > increased secretion > distension > inflammatory response
name 3 severe complications of gallstones
pus empyema gangrene perforation peritonitis pancreatitis
