cholecystitis

Question 1

define cholecystitis?

Answer 1

inflammation of the gallbladder

Question 2

what is the major cause of cholecystitis?

Answer 2

Develops secondary to gallstones in 90% of cases.

Question 3

what are the risk factors for cholecystitis?

Answer 3

o	Age  
o	Female  
o	Fat 
o	Diabetes mellitus  
o	Drugs (OCP, octreotide)  
o	Family history  
o	Ethnicity (Caucasian)  
o	Pigment Stone Risk Factors:

Question 4

what is the epidemiology of cholecystitis?

Answer 4

• Very COMMON
• 3 x more common in FEMALES
• More common with increasing age

Question 5

presenting symptoms of cholecystitis?

Answer 5

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

Question 6

how to perform murphys?

Answer 6

• palpate the gallbladder area medial to the midclavicular line
• ask patient to inspire
• murphys is positive if the patient stops breathing in

Question 7

gold standard investigation for cholecystitis?

Answer 7

USS

• shows gallstones
• shows thickened gallbladder wall

Question 8

bloods for cholecystitis?

Answer 8

• high WCC
• blood cultures
• no amylase
• LFTs are normal

Question 9

other investigation for unclear diagnosis?

Answer 9

HIDA scan

Question 10

medical management for cholecystitis?

Answer 10

o	IV antibiotics 
o	NBM  
o	IV fluids  
o	Analgesia 
o	Anti-emetics

Question 11

surgical management for cholecystitis?

Answer 11

o Laparoscopic Cholecystectomy within 1 week of diagnosis

Question 12

complications?

Answer 12

•	Stones within the gallbladder 
o	Biliary colic  
o	Cholecystitis  
o	Gallbladder empyema 
o	Gallbladder cancer (RARE) 
•	Stones outside the gallbladder 
o	Obstructive jaundice  
o	Pancreatitis  
o	Ascending cholangitis  
o	Cholecystoduodenal fistula  
o	Gallstone ileus  
o	Bouveret syndrome (gallstones cause gastric outlet obstruction)  
o	Mirizzi syndrome  
•	Complications of cholecystectomy 
o	Bleeding  
o	Infection  
o	Bile leak  
o	Post-cholecystectomy syndrome  
o	Port-site hernia

Question 13

prognosis ?

Answer 13

very good with surgery