Cholecystitis Flashcards
Define Cholecystitis?
Inflammation of the gallbladder
What are the types of stones that can cause Cholecystitis?
Mixed Stones (80%) Pure Cholesterol Stones (10%) Pigment Stones (10%)
What are the Mixed Stones that can cause Cholecystitis?
Contains cholesterol, calcium bilirubinate, phosphate and protein
Form due to an imbalance between bile salts, phospholipids, cholesterol, nucleation factors and gallbladder motility
What are the Pigment Stones that can cause Cholecystitis?
Black stones made of calcium bilirubinate
Form due to increased bilirubin (e.g. due to haemolysis)
What are the risk factors for Cholecystitis?
Age Female DM Drugs (OCP, Octreotide) Family History Ethnicity (Caucasian) Pigment Stone Risk Factors
What are Pigment Stone risk factors?
Haemolytic Disorders (e.g. sickle cell anaemia)
What is the epidemiology of Cholecystitis?
Very COMMON
UK prevalence of gallstone disease = 10%
3 x more common in FEMALES
More common with increasing age
What are the presenting symptoms of Cholecystitis?
Systemically unwell
Fever
Prolonged Abdominal Pain
Pain may be referred to right shoulder (due to diaphragmatic irritation)
What are the signs of Cholecystitis on physical examination?
Tachycardia Pyrexia RUQ pain or epigastric tenderness May be guarding or rebound tenderness Murphy's Sign positive
How do you examine Murphy’s Sign?
Ask patient to exhale
Examiner places hand below costal margin on the right side at the mid-clavicular line
The patient is instructed to inspire
What is a Positive Murphy’s Sign?
The patient stops breathing in and winces with a ‘catch’ IN breath due to the inflamed gallbladder being palpated as it descends on insipration
What bloods would you do for Cholecystitis?
FBC
LFT
Blood Cultures
Amylase
What would you look for specifically for Cholecystitis?
High WCC in Cholecystitis and cholangitis
What would you look for specifically on LFTs for Cholecystitis?
High ALP + GGT in ascending cholangitis
Why do we do Amylase tests for Cholecystitis?
To exclude pancreatitis
Why do we do an US for Cholecystitis?
Shows gallstones
Increased thickness of gallbladder wall
Dilatation of biliary tree
What is the problem of doing an AXR for Cholecystitis?
Only 10% of gallstones are radio-opaque
What other imaging would you do for Cholecystitis and why?
Erect CXR
ERCP
To exclude differentials
What is the conservative management plan for Cholecystitis?
If only mild biliary colic - follow a low-fat diet
What is the medical management plan for Cholecystitis?
NBM IV Fluids Analgesia Anti-emetics Antibiotics (if infection is present)
What do you suspect and do if symptoms persist despite antibiotic treatment in Cholecystitis?
Suspect a localised abscess or empyema
This requires drainage
What do you do if there is an obstruction for Cholecystitis?
Urgent biliary drainage by ERCP or via percutaneous route is necessary
What is the surgical management plan for Cholecystitis?
Laparoscopic Cholecystectomy
What are the complications of stones within the gallbladder?
Biliary Colic
Cholecystitis
Gallbladder Empyema
Gallbladder Cancer (RARE)
What are the complications of Stones outside the gallbladder?
Obstructive Jaundice Pancreatitis Ascending Cholangitis Cholecystoduodenal Fistula Gallstone ileus Bouveret Syndrome (gallstones cause gastric outlet obstruction) Mirizzi Syndrome
What are the complications of Cholecystectomy?
Bleeding Infection Bile Leak Post-Cholecystectomy Syndrome Port-Site Hernia
What is the prognosis for patients with Cholecystectomy?
Gallstones don’t cause symptoms most of the time
Surgery offers an excellent chance of cure if they were to become symptomatic
