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Gastrointestinal > Cholecystitis > Flashcards

Cholecystitis Flashcards

1
Q

Define Cholecystitis?

A

Inflammation of the gallbladder

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2
Q

What are the types of stones that can cause Cholecystitis?

A 
Mixed Stones (80%)
Pure Cholesterol Stones (10%)
Pigment Stones (10%)
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3
Q

What are the Mixed Stones that can cause Cholecystitis?

A

Contains cholesterol, calcium bilirubinate, phosphate and protein
Form due to an imbalance between bile salts, phospholipids, cholesterol, nucleation factors and gallbladder motility

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4
Q

What are the Pigment Stones that can cause Cholecystitis?

A

Black stones made of calcium bilirubinate

Form due to increased bilirubin (e.g. due to haemolysis)

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5
Q

What are the risk factors for Cholecystitis?

A 
Age
Female 
DM
Drugs (OCP, Octreotide)
Family History
Ethnicity (Caucasian)
Pigment Stone Risk Factors
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6
Q

What are Pigment Stone risk factors?

A

Haemolytic Disorders (e.g. sickle cell anaemia)

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7
Q

What is the epidemiology of Cholecystitis?

A

Very COMMON
UK prevalence of gallstone disease = 10%
3 x more common in FEMALES
More common with increasing age

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8
Q

What are the presenting symptoms of Cholecystitis?

A

Systemically unwell
Fever
Prolonged Abdominal Pain
Pain may be referred to right shoulder (due to diaphragmatic irritation)

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9
Q

What are the signs of Cholecystitis on physical examination?

A 
Tachycardia
Pyrexia
RUQ pain or epigastric tenderness 
May be guarding or rebound tenderness 
Murphy's Sign positive
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10
Q

How do you examine Murphy’s Sign?

A

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

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11
Q

What is a Positive Murphy’s Sign?

A

The patient stops breathing in and winces with a ‘catch’ IN breath due to the inflamed gallbladder being palpated as it descends on insipration

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12
Q

What bloods would you do for Cholecystitis?

A

FBC
LFT
Blood Cultures
Amylase

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13
Q

What would you look for specifically for Cholecystitis?

A

High WCC in Cholecystitis and cholangitis

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14
Q

What would you look for specifically on LFTs for Cholecystitis?

A

High ALP + GGT in ascending cholangitis

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15
Q

Why do we do Amylase tests for Cholecystitis?

A

To exclude pancreatitis

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16
Q

Why do we do an US for Cholecystitis?

A

Shows gallstones
Increased thickness of gallbladder wall
Dilatation of biliary tree

17
Q

What is the problem of doing an AXR for Cholecystitis?

A

Only 10% of gallstones are radio-opaque

18
Q

What other imaging would you do for Cholecystitis and why?

A

Erect CXR
ERCP

To exclude differentials

19
Q

What is the conservative management plan for Cholecystitis?

A

If only mild biliary colic - follow a low-fat diet

20
Q

What is the medical management plan for Cholecystitis?

A 
NBM
IV Fluids
Analgesia
Anti-emetics 
Antibiotics (if infection is present)
21
Q

What do you suspect and do if symptoms persist despite antibiotic treatment in Cholecystitis?

A

Suspect a localised abscess or empyema

This requires drainage

22
Q

What do you do if there is an obstruction for Cholecystitis?

A

Urgent biliary drainage by ERCP or via percutaneous route is necessary

23
Q

What is the surgical management plan for Cholecystitis?

A

Laparoscopic Cholecystectomy

24
Q

What are the complications of stones within the gallbladder?

A

Biliary Colic
Cholecystitis
Gallbladder Empyema
Gallbladder Cancer (RARE)

25
Q

What are the complications of Stones outside the gallbladder?

A 
Obstructive Jaundice 
Pancreatitis 
Ascending Cholangitis 
Cholecystoduodenal Fistula 
Gallstone ileus 
Bouveret Syndrome (gallstones cause gastric outlet obstruction)
Mirizzi Syndrome
26
Q

What are the complications of Cholecystectomy?

A 
Bleeding
Infection
Bile Leak
Post-Cholecystectomy Syndrome
Port-Site Hernia
27
Q

What is the prognosis for patients with Cholecystectomy?

A

Gallstones don’t cause symptoms most of the time

Surgery offers an excellent chance of cure if they were to become symptomatic

Gastrointestinal (61 decks)

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