Cholecystitis

Question 1

Define cholecystitis

Answer 1

Inflammation of the gallbladder

Question 2

Aetiology of cholecystitis

3 types

Answer 2

Mixed stones (80%)
Contains cholesterol, calcium bilirubinate, phosphate & protein

Pure cholesterol stones (10%)

Pigment stones (10%)
Form due to increased bilirubin (e.g. due to haemolysis)

Question 3

Risk factors for cholecystitis

7 + rare

Answer 3

Age
Female
Fat
Diabetes mellitus
Drugs (OCP, octreotide)
FH
Ethnicity (Caucasian)

Risk factors for pigment stones
Haemolytic disorders (e.g SCA)

Question 4

Epidemiology of cholecystitis

general, gender, age

Answer 4

Very common
3x more common in females
More common w/ increasing age

Question 5

Presenting symptoms of cholecystitis

4

Answer 5

Systemically unwell
Fever
Prolonged abdo pain
Pain may be referred to right shoulder

Question 6

Signs of cholecystitis on physical examination

5

Answer 6

Tachycardia
Pyrexia
RUQ pain or epigastric tenderness
May be guarding or rebound tenderness
Murphy’s sign positive

Question 7

Describe how to elicit Murphy’s sign & positive finding

Answer 7

Murphy’s sign:

1) Patient exhales
2) Place hand below right costal margin at MCL
3) Patient inspires

Positive sign = patient stops breathing in & winces w/ “catch” in breathe

Question 8

Investigations for cholecystitis

3 + 2 exclusion

Answer 8

Bloods
US
AXR

Erect CXR
ERCP

Question 9

Investigations for cholecystitis - bloods

4

Answer 9

FBC - high WCC in cholecystitis & cholangitis
LFT - high ALP & GGT in ascending cholangitis
Blood cultures
Amylase - exclude pancreatitis

Question 10

Investigations for cholecystitis - US

3

Answer 10

Shows gallstones
Increased thickness of gallbladder wall
Dilatation of biliary tree

Question 11

Investigations for cholecystitis - AXR

1

Answer 11

Only 10% stones are radio-opaque

Question 12

Types of management of cholecystitis

3

Answer 12

Conservative
Medical
Surgical

Question 13

Management of cholecystitis - conservative

1

Answer 13

If only mild biliary colic, follow low fat diet

Question 14

Management of cholecystitis - medical

5 + 2

Answer 14

NBM
IV fluids
Analgesia
Anti emetics
Antibiotics (if infection)

If symptoms persist despite antibiotics, localised abscess or empyema suspected
would require drainage
If there’s an obstruction, urgent biliary drainage by ERCP or percutaneous route necessary

Question 15

Management of cholecystitis - surgical

1

Answer 15

Laprascopic cholecystectomy

Question 16

Complications of cholecystitis can be due to

2

Answer 16

Location of stones

Cholecystectomy

Question 17

Complications of cholecystitis - stones within gallbladder

4

Answer 17

Biliary colic
Cholecystitis
Gallbladder empyema
Gallbladder cancer (RARE)

Question 18

Complications of cholecystitis - stones outside gallbladder

7

Answer 18

Obstructive jaundice
Pancreatitis
Ascending cholangitis
Cholecystoduodenal fistula
Gallstone ileus
Bouveret syndrome 
Mirizzi syndrome

Question 19

Complications of cholecystitis - cholecystectomy

5

Answer 19

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

Question 20

Prognosis of cholecystitis

2

Answer 20

Gallstones do not cause symptoms most of the time

Surgery gives high chance of cure if symptomatic