Gallbladder Disease - Acute Cholecystitis

Question 1

What is Acute Cholecystitis?

Answer 1

Inflammation of the gallbladder.

Question 2

Types/Aetiology of Acute Cholecystitis (2).

Answer 2

1. 95% - Calculous Cholecystitis : gallstones are trapped in the neck of the gallbladder or in the cystic duct - occlusion for a prolonged period of time will rub and damage the mucosal lining to incite an acute inflammatory response.
2. Acalculous Cholecystitis - dysfunction in gallbladder emptying caused by something else.

Question 3

Causes of Acalculous Cholecystitis (4).

Answer 3

1. TPN/Long Periods of Fasting - Gallbladder is not being stimulated by food to regularly empty to pressure builds up.
2. Gallbladder Stasis, Hypoperfusion (cystic artery is an end artery with no collateral) and Infection.
3. Immunosuppression : Cryptosporidium or CMV.
4. Hospitalised and Severely Ill Patients.

Question 4

Clinical Presentation of Acute Cholecystitis (3).

Answer 4

1. RUQ Pain that may radiate to the Right Shoulder (if diaphragm is irritated).
2. Fever, Nausea & Vomiting.
3. Murphy’s Sign Positive.

Question 5

What is Murphy’s Sign?

Answer 5

When applying pressure in the RUQ with a hand, as the patient breathes in, the gallbladder moves downwards and comes into contact with your hand to result in acute pain.

Question 6

Investigations of Acute Cholecystitis (3).

Answer 6

1. Abdominal US Scan - Thickened Gallbladder Wall, Stones/Sludge in Gallbladder, Fluid around Gallbladder.
2. MRCP.
3. HIDA Scan (Cholescintigraphy).

Question 7

Management of Acute Cholecystitis (5).

Answer 7

1. Emergency Admission for Investigations and Management.
2. Conservative - NBM, IV Fluids, Antibiotics and NG Tube (vomiting).
3. ERCP - remove stones trapped in the common bile duct.
4. Cholecystectomy within 72 hours - within 1 week.
5. Cholecystostomy (Percutaneous) if acutely unwell to drain any collections/discharge before delayed cholecystectomy in severe cases.

Question 8

Complications of Acute Cholecystitis (4).

Answer 8

1. Sepsis.
2. Gallbladder Empyema.
3. Gangrenous Gallbladder.
4. Perforation.

Question 9

Bloods in Acute Cholecystitis.

Answer 9

LFTs are typically normal - Deranged LFTs may indicate Mirizzi Syndrome (gallstone impacted in the distal cystic duct to cause extrinsic compression of the common bile duct).

Question 10

Causative Pathogens of Acute Cholecystitis (3).

Answer 10

1. E. coli (commonest).
2. Klebsiella.
3. Enterococcus.

Question 11

What is Chronic Cholecystitis?

Answer 11

Repeated episodes of biliary colic and acute cholecystitis result in chronic inflammation with healing by fibrosis causes the gallbladder wall to become thickened and the gallbladder to shrink.

Question 12

Clinical Features of Chronic Cholecystitis.

Answer 12

Same and FLATULENT DYSPEPSIA.