cholecystitis

Question 1

what is it?

its a major complication of what?

Answer 1

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

Question 2

There are 2 broad causes of this. what are they?

Answer 2

1. Gallstones
   In most cases (90%), it is caused by complete cystic duct obstruction usually due to an impacted gallstone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall. [1]
2. Acalculous cholecystitis;
   In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing an acalculous cholecystitis.

Question 3

presenting symptoms?

Answer 3

RUQ pain
Right shoulder pain -due to diaphragmatic irritation
Nausea
Fever

others;
jaundice
vomiting

Question 4

presenting signs?

Answer 4

1. Murphy’s sign positive - right subcostal tenderness on inspiration and palpation
2. abdominal distension - inflammed gallbladder

Palpable tender mass in the right upper abdominal quadrant - sign of mod-severe disease

Tachycardia

Pyrexia

RUQ pain or epigastric tenderness

May be guarding or rebound tenderness

Question 5

Risk factors?

Answer 5

female
gallstones
severe illness; burns, trauma 
diabetes
total parenteral nutrition - gall bladder hypomotility - biliary sludge etc

low fibre
ceftriaxone - causes stone formation
ciclosporin - immunosuppresant - chrons

Question 6

ivx?

Answer 6

FBC - WCC elevated
CRP - high
Lfts - high ALP, GGT, bilirubin

INR - increased (mod-sev)
low platelets (mod-sev)

RUQ ultrrasound - distended gallbladder, thickened gallbladder wall, gallstones, positive Murphy’s sign

In AnE do PR with abdominal pain presentation

Question 7

management for mild and moderate acute cholecystitis?

Answer 7

TOKYO score for severity

NPO, intravenous fluids, antibiotics (cefuroxime*), and analgesia,

together with close monitoring of blood pressure, pulse, and urinary output

1. Lap cholecystectomy

If there is an obstruction, urgent biliary drainage by ERCP or via a percutaneous route is necessary (involves insertion of catheter)

• in moderate disease, must give abx via iv + cholecystectomy
• not ceftriaxone this time

Question 8

management for severe acute cholecystitis?

Answer 8

its urgent when there is hypotention, deranged renal funciotns - high creatinine etc

ITU - all the basics

iv abx

percutaneous cholecystectomy urgently