(!) Cholecystitis

Question 1

Define Acute Cholecystitis

Answer 1

Inflammation of the gallbladder due to blockage of the bile duct -mainly gallstones
main complications of gallstones or bile stasis
can be caused by dehydration
often with secondary infection

Question 2

Aetiology and risk factors of Acute Cholecystitis

Answer 2

At least 90% of pt have gallstones (and 10% of symptomatic GS become cholecystitis)
Occasionally happens after dehydration or total parenteral nutrition (stasis)
Secondary infection (not causing event) usually gram -ve flora (E.coli, Kleb, Pseudomon)
some resolve after a week

Risk factors
Gallstones
Dehydration
Severe illness
Total parenteral nutrition
diabetes
physical inactivity
3x women under 50
1.5 x men above 50

Question 3

Epidiemology of Acute Cholecystitis

Answer 3

15% of adults get gallstones
about 1% of those become symptomatic each year
and about 10% of those get Acute Cholecystitis

acalculous cholecystitis is about 10% of all Acute Cholecystitis

Question 4

Signs and Sx of Acute Cholecystitis

Answer 4

Constant (several hours) severe RUQ pain
Nausea, Vom
Fever/chills
Loss of appetite
Hx of billiary pain/gallstones
Jaundice
pain can radiate to back/shoulder

with or without Murphy’s sign,
Not palpable mass (if palpable gallbladder-pancreatic cancer)

Question 5

Investigations of Acute Cholecystitis

Answer 5

Inflammation-
WCC up, CRP up, ferritin up
Billirubin up
LFT-ALP up, AST/ALT oki
amylase-normal
Bile cultures

but 1st line-ultrasound-gallstones, distended gallbladder, thickened wall
CT-same + gas in lumen, visible abscesses

Question 6

Management of Acute Cholecystitis

Answer 6

Mild-no other organ involvement-
Analgesia (NSAID), fluids
Abx (note: e.coli most common), cholecystectomy (laparoscopy preferred)
post op management

Severe-other organ involved-send to ICU-> treat organ failure
+normal rest of management

Question 7

Complications of Acute Cholecystitis

Answer 7

Perforation of gallbladder and abscess formation
Liver failure
Septic shock

Gallstone obstruction of intestines (illeus)-usually 4-6 weeks after

Fistulas to the duodenum or hepatic flexure of colon

gallbladder removal-streatorhea, hard time eating fatty meals

Question 8

Prognosis of Acute Cholecystitis

Answer 8

If diagnosed early and gall bladder removed-good
If perforates mortality is 30%
untreated-mortality 50%