Cholecystitis

Question 1

Define

Answer 1

Acute gallbladder inflammation caused by an obstruction at the cystic duct

Question 2

Aetiology/risk factors

Answer 2

Acute: Stone or sludge impaction in the neck of the gallbladder
Chronic: Chronic inflammation and colic

Question 3

epidemiology

Answer 3

8% of >40yrs.

6 Fs: Fat, Forty, Female, Fertile, Fai Family history

Question 4

Symptoms

Answer 4

• Patient systemically unwell
• Fever
• Prolonged upper abdominal pain that may be referred to right shoulder (due to diaphragmatic irritation)

Question 5

signs

Answer 5

• Tachycardia
• Pyrexia
• Right upper quadrant or epigastric tenderness
• They may be guarding. With or without rebound
• Murphy’s signs is elicited by placing a hand at the costal margin in the RUQ and asking patient to breathe deeply
• Patient stops breathing as the inflamed gallbladder descends and contacts the palpating fingers

Question 6

investigations

Answer 6

• Ultrasound: image stones and assess CBD diameter

- MRCP: to find CBD stones

Question 7

management

Answer 7

Cholecystectomy
- If US shows dilated GB with stones → ERCP and sphincterotomy before surgery

Clear fluids (NBM)
IV fluids (to stop dehydration)
Analgesia
Antibiotics 
Anti-emetics

Question 8

complications

Answer 8

• Perforation
• Suppurative cholecystitis
• Gangrenous cholecystitis
• Bile duct injury due to surgery
• Gallstone ileus

Question 9

prognosis

Answer 9

Removing the gallbladder and the contained gallstones when biliary pain starts will prevent further biliary attacks and reduce the risk of developing cholecystitis. If the gallbladder perforates, mortality is 30%.

Untreated acute acalculous cholecystitis is life-threatening and is associated with up to 50% mortality.

Question 10

Complications of the cholecystectomy

Answer 10

• Bile leek
• Bleeding
• Blood clots
• Infection
• Pancreatitis
• Pneumonia
• Post-cholecystectomy syndrome