Cholecystitis and Cholecystectomy

Question 1

What is Cholecystitis?

Answer 1

Acute cholecystitis is acute gallbladder inflammation, and one of the major complications of cholelithiasis or gallstones

Question 2

What are the RFs for cholecystitis?

Answer 2

> gallstones
severe illness
total parenteral nutrition (TPN)
diabetes

Question 3

What is the epidemiology of cholecystitis?

Answer 3

The distribution and incidence of acute cholecystitis follow that of cholelithiasis because of the close relationship between the two.

The prevalence rates are relatively low in Africa and Asia

F>M 3:1

Question 4

What are the signs and symptoms of cholecystitis?

Answer 4

Previous biliary pain
RUQ pain
Positive murphys sign
Abdominal mass
Right shoulder pain
Anorexia
nausea
Fever
Vomiting 
Jaundice

Question 5

What investigations would you use for cholecystitis and how would you interpret them?

Answer 5

FBC (High WBC)
CRP (High)
LFTs (High Alk Phos, GGT and BR)
RUQ US scan (Thickened GB wall, distended GB, fluid, +ve murphys sign)

Question 6

How do you manage cholecystitis?

Answer 6

> Supportive care (NBM, IV fluids, analgesia, Abx)
> Oral Abx (e.g. cefuroxime)
> NSAIDs
> Cholecystectomy
> GB drainage

Question 7

What complications may occur in cholecystitis?

Answer 7

> Perforation
> Suppurative cholecystitis
> Gangrenous Cholecystitis
> Bile duct injury
> Gallstone ileus

Question 8

What is the prognosis of patients with cholecystitis?

Answer 8

> Lower risk of mortality if no perforation or if found on time

Question 9

What is a cholecystectomy?

Answer 9

Removal of the gallbladder

Question 10

What are the complications of a cholecystectomy?

Answer 10

> Infection
> bleeding
> Bile leakage
> Tissue injury 
> DVT