Gallbladder / Cholecystitis Flashcards
Define Cholecystitis
Inflammation / Infection to the cystic duct
Most common cause of cholecystitis
gallstones
5F’s
Gallstone disease risk factors
Fat
Female
Fertile
Forty
Family history
Define Biliary colic
The pain experienced when the gallbladder neck becomes impacted by a gallstone
Biliary colic Sx
- sudden, dull, colicky pain
- RUQ
- usually triggered by a fatty meal
Cholecystitis special test
Murphy’s sign
What is the Murphy’s sign
Whilst applying pressure in the RUQ, ask the patient to inspire. Murphy’s sign is positive when there is a halt in inspiration due to pain, indicating an inflamed gallbladder
1st line imaging Ix for cholecystitis
Abdo USS
Abdo USS features for cholecystits
- The presence of gallstones or sludge
- Gallbladder wall thickness (if thick walled, then inflammation is likely)
- Bile duct dilatation (indicates a possible stone in the distal bile ducts)
what imaging Ix is used when abdo USS is inconclusive
Magnetic Resonance Cholangiopancreatography (MRCP)
how does pregnancy and COCP increase risk of gallstone formation
Oestrogen causes more cholesterol to be secreted into bile
Acute cholecystitis Sx
- RUQ or Epigatric pain
- Fever
- Lethergy
Acute cholecystitis clinical signs
- Positive Murphy’s sign
- RUQ tenderness
Abdo examination indication of gallbladder perforation
Guarding
Define Gallbladder Empyema
A gallbladder empyema is when the gallbladder becomes filled with pus
Gallbladder Empyema Tx
- Laparoscopic cholecystectomy
- Percutaneous cholecystostomy
Acute cholecystitis Mx
- IV Abx (Co-amox / Metronidazole)
- Analgesia
- Antiemetics
Time frame for **laparoscopic cholecystectomy **of Acute cholecystitis
Within 1 week of presentation
Acute cholecystitis not fit for surgery intervention
Percutaneous cholecystostomy
Medical term for gallbladder stones
cholelithiasis
Define Gallbladder mucocoele
a condition where the gallbladder becomes distended and filled with sterile mucus due to obstruction of the cystic duct.
Gallbladder mucocoele Sx
- RUQ pain - dull, persistent, worse post meal
- N + V
- Fever
Gallbladder mucocoele clinical signs
- Palpable RUQ mass - Distended, non-tender gallbladder
- Septic - hypotension, Tachycardic, Tachypnoeic
- Fever
Gallbladder mucocoele USS features
- Distended, thin-walled gallbladder with anechoic (no sound) content.
- No gallstones (unlike typical cholecystitis)
Definitice Tx for gallbladder mucocoele
Cholecystectomy
untreated Gallbladder mucocoele complications
- Gallbladder Empyema – pus accumulation
- Gangrene and Perforation – Ischemia may lead to necrosis and rupture.
- Peritonitis – Due to gallbladder perforation.
- Biliary Peritonitis – Leakage of bile into the peritoneal cavity
Medical term for CBD stones
Choledocholithiasis
Laparoscopic cholestectomy complications
- Bleeding
- damage to bile ducts
- damage to bowel, blood vessels and organs
- VTE
- Stones left in bile duct
- Anaesthetic risks
- Post-cholestectomy syndrome
Post-cholestectomy syndrome Sx
- diarrhoea
- indigestion
- RUQ pain
- Nausea
- Flactulence
- intolerance of fatty food
