cholecystitis

Question 1

definition

Answer 1

Acute cholecystitis is acute gallbladder inflammation, and one of the major complications of cholelithiasis or gallstones. It develops in up to 10% of patients with symptomatic gallstones. In most cases (90%), it is caused by complete cystic duct obstruction usually due to an impacted gallstone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall. In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing an acalculous cholecystitis

Question 2

summary

Answer 2

Major complication of cholelithiasis (i.e., gallstones); symptomatic gallstones are common before developing cholecystitis.

Patients typically present with pain and localised tenderness, with or without guarding, in the upper right quadrant.

There may be evidence of a systemic inflammatory response with fever, elevated white cell count, and raised C-reactive protein.

Ultrasound is the definitive initial test. Magnetic resonance cholangiopancreatography may be required. In a patient with suspected sepsis, use computed tomography (or magnetic resonance imaging)to identify the cause.

Treatment is with antibiotics, analgesia, and fluid resuscitation as required, likely to be followed by an early cholecystectomy.

Question 3

symptoms

Answer 3

• right upper quadrant pain and tenderness
• signs of inflammation:
  Fever
  Elevated white cell count
  Elevated CRP
  Elevated ESR
• palpable distended, tender gallbladder

Question 4

investigations

Answer 4

1st investigations:

• USS abdo
• CT/MRI abdo
• LFTs
• FBC
• CRP
• bilirubin
• serum lipase or amylase
• blood cultures and/or bile cultures (in patients with grade II (moderate) and III (severe) disease in order to identify an infection that may be the cause of sepsis.)

others:
- MRCP

Question 5

treatment

Answer 5

analgesia
fluid resuscitation
antibiotics
cholecystectomy

Question 6

complications

Answer 6

• suppurative cholecystitis aka gallbladder empyema (Thickened gallbladder wall with white cell infiltration, intra-wall abscesses, and necrosis. This may result in perforation of the gallbladder and a pericholecystic abscess formation.)
• gallstone ileus (Caused by a gallstone passing from the biliary tract into the intestinal tract (through a fistula), leading to small-intestinal obstruction)
• bile duct injury due to surgery