Cholecystitis

Question 1

pathophysiology?

Answer 1

inflammation of wall of gall bladder

Question 2

aetiology?

Answer 2

• majority by impacted gallstones
• other: injury during surgery / septicaemia

Question 3

symptoms?

Answer 3

• constant RUQ pain
  
  • +/- referred pain radiating to tip of right scapula
• fever
• vomiting

Question 4

signs?

Answer 4

• tenderness, rebound and guarding in RUQ
• Murphy’s sign
  
  • RUQ tenderness exacerbated by deep inspiration
  • place hand in RUQ & apply pressure and ask pt to take deep breath in
  • the gallbladder moving downwards towards hand will cause pain

Question 5

Ix?

Answer 5

• FBC- raised inflammatory markers
• USS

Question 6

what US findings may you find in cholecystitis?

Answer 6

• thickened gall bladder wall
• gallstones
• sludge in gallbladder
• fluid around gallbladder

Question 7

Mx?

Answer 7

• Conservative
  
  • NBM
  • Analgesia
  • IV fluids
  • Abx - cefuroxime & metronidazole
• Surgery - laparoscopic cholecystectomy
  
  • not usually done until 6 weeks or so post infection

Question 8

complications?

Answer 8

• chronic cholecystitis
• mucocele (distends w bile)
• empyema
• gangrene and perforation