Cholecystitis

Question 1

What is cholecystitis? What is it usually caused by?

Answer 1

inflammation of the gallbladder

Caused by obstruction of the cystic duct by a gallstone

Question 2

List 3 types of stones that can form in the gallbladder

Answer 2

Cholesterol Stones
Mixed Stones
Pigment Stones: due to increased BR (e.g. haemolysis)

Question 3

Describe the epidemiology of cholecystitis

Answer 3

Very COMMON
F > M
Peak incidence >50

Question 4

List 8 risk factors for cholecystitis

Answer 4

Age  
Female  
Fat 
FH  
Diabetes mellitus  
Drugs (OCP, octreotide)  
Ethnicity (Caucasian)  
Pigment Stone RF: haemolytic disorders (e.g. SCA)

Question 5

List 5 presenting symptoms of cholecystitis

Answer 5

Systemically unwell  
Fever 
Prolonged abdominal pain  
Pain referred to right shoulder (due to diaphragmatic irritation) 
N+V

Question 6

List 5 signs of cholecystitis

Answer 6

RUQ pain
Positive Murphy's sign 
Fever
Tachycardia  
May be guarding or rebound tenderness

Question 7

Which bloods should be investigated in cholecystitis?

Answer 7

FBC: high WCC, high CRP

Amylase (exclude pancreatitis)

Question 8

What imaging should be performed in cholecystitis?

Answer 8

USS: distension, wall thickening, gallstones, oedema + pericholecystic fluid

AX: but only 10% of gallstones are radio-opaque
Other imaging: to exclude ddx (e.g. CXR, ERCP)

Question 9

What is the conservative management plan for cholelithiasis ?

Answer 9

If only mild biliary colic:

Follow a low-fat diet

Question 10

List 4 possible complications of Stones within the gallbladder

Answer 10

Biliary colic
Cholecystitis
Gallbladder empyema
Gallbladder cancer (RARE)

Question 11

What is the prognosis for patients with cholecystectomy?

Answer 11

Gallstones do NOT cause symptoms most of the time

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

Question 12

What is the medical management plan for cholecystitis?

Answer 12

NBM
IV fluids
Analgesia
Anti-emetics
Abx (if infection is present)
If symptoms persist despite abx tx, suspect a localised abscess or empyema, which would require drainage
If there is an obstruction, urgent biliary drainage by ERCP or via a percutaneous route is necessary

Question 13

What is the surgical management plan for cholecystitis?

Answer 13

Laparoscopic Cholecystectomy

Question 14

How do you elicit Murphy’s sign?

Answer 14

1. Ask pt to exhale
2. Place hand below costal margin on the right side MCL
3. Instruct pt to Inspire
   Positive Murphy’s Sign=
   Pt stops breathing in + winces with a ‘catch’ in breath
   (as inflamed gallbladder being palpated as it descends on inspiration)

Question 15

List 5 complications of stones outside the gallbladder

Answer 15

Obstructive jaundice  
Pancreatitis  
Ascending cholangitis  
Cholecystoduodenal fistula  
Gallstone ileus    
Mirizzi syndrome

Question 16

List 5 complications of cholecystectomy

Answer 16

Bleeding  
Infection  
Bile leak  
Post-cholecystectomy syndrome  
Port-site hernia