cholecystitis Flashcards
1
Q
define cholecystitis?
A
inflammation of the gallbladder
2
Q
what is the major cause of cholecystitis?
A
Develops secondary to gallstones in 90% of cases.
3
Q
what are the risk factors for cholecystitis?
A
o Age o Female o Fat o Diabetes mellitus o Drugs (OCP, octreotide) o Family history o Ethnicity (Caucasian) o Pigment Stone Risk Factors:
4
Q
what is the epidemiology of cholecystitis?
A
- Very COMMON
- 3 x more common in FEMALES
- More common with increasing age
5
Q
presenting symptoms of cholecystitis?
A
- Tachycardia
- Pyrexia
- RUQ pain or epigastric tenderness
- May be guarding or rebound tenderness
- Murphy’s sign positive
6
Q
how to perform murphys?
A
- palpate the gallbladder area medial to the midclavicular line
- ask patient to inspire
- murphys is positive if the patient stops breathing in
7
Q
gold standard investigation for cholecystitis?
A
USS
- shows gallstones
- shows thickened gallbladder wall
8
Q
bloods for cholecystitis?
A
- high WCC
- blood cultures
- no amylase
- LFTs are normal
9
Q
other investigation for unclear diagnosis?
A
HIDA scan
10
Q
medical management for cholecystitis?
A
o IV antibiotics o NBM o IV fluids o Analgesia o Anti-emetics
11
Q
surgical management for cholecystitis?
A
o Laparoscopic Cholecystectomy within 1 week of diagnosis
12
Q
complications?
A
• Stones within the gallbladder o Biliary colic o Cholecystitis o Gallbladder empyema o Gallbladder cancer (RARE) • Stones outside the gallbladder o Obstructive jaundice o Pancreatitis o Ascending cholangitis o Cholecystoduodenal fistula o Gallstone ileus o Bouveret syndrome (gallstones cause gastric outlet obstruction) o Mirizzi syndrome • Complications of cholecystectomy o Bleeding o Infection o Bile leak o Post-cholecystectomy syndrome o Port-site hernia
13
Q
prognosis ?
A
very good with surgery
