CHOLECYSTITIS Flashcards
WHAT IS CHOLESYSTITIS?
- gall bladder inflammation developing secondary to gall stone in cystic duct
WHAT ARE THE RISK FACTORS FOR CHOLECYSTITIS?
1) fat
2) female
3) forty
4) fertile
WHAT ARE THE SYMPTOMS OF CHOLESYSTITIS?
1) RUQ abdominal pain
2) Fever
3) Nausea
4) Vomiting
WHAT ARE THE SIGNS OF CHOLECYSTITIS?
1) Murphy’s sign positive
2) RUQ abdominal tenderness
3) Tachycardia
WHAT IS MURPHY’S SIGN AND HOW IS IT ELICITED?
- pain on inspiration during palpation of RUQ
- ask patient to take in and hold a deep breath and palpate right subcostal area.
- If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
WHAT ARE THE LABORATORY INVESTIGATIONS OF CHOLECYSTITIS?
- Blood test- FBC (elevated WCC), U+E (dehydration), LFTS (raised ALP due to ductal occlusion), amylase (pancreatitis), CRP (inflammation)
- Urinalysis - exclude renal pathology
- Pregnancy test
WHAT IS THE IMAGING INVESTIGATION OF CHOLESYSTITIS?
1) Transabdominal US
if inconclusive
2) MRCP
WHAT IS THE INITIAL MANAGEMENT FOR CHOLECYSTITIS?
1) IV antibiotics - coamixoclav
2) IV fuid resuscitation
3) Concurrent analgesia (simple analgesia and opioid PRN)
4) antiemetics
5) NG tube if patient vomiting and NBM
WHAT IS THE DEFINITIVE MANAGEMENT FOR CHOLECYSTITIS?
1) Laparoscopic cholecystectomy within 1 week
WHAT ALTERNATIVE MANAGEMENT IS AVAILABLE FOR THOSE NOT FIR FOR SURGERY?
1) Percutaneous cholecystectomy to drain infection
WHAT NEEDS TO BE EXCLUDED WHEN A PATIENT IS A READMITTED FOR RUQ PAIN, POST- OP CHOLECYSTECTOMY?
1) Retained common bile duct (CBD) stone via US or if inconclusive MRCP.
WHAT ARE THE COMPLICATIONS OF CHOLECYSTITIS?
- gall bladder empyema - infection forming abscess, gall bladder filled with purulent material, septic
- chronic cholecystitis.
WHAT ARE THE DIFFERENTIAL DIAGNOSIS FOR CHOLECYSTITIS?
1) biliary colic
2) ascending cholangitis
3) acute pancreatitis
