Gallbladder / Cholecystitis

Question 1

Define Cholecystitis

Answer 1

Inflammation / Infection to the cystic duct

Question 2

Most common cause of cholecystitis

Answer 2

gallstones

Question 3

5F’s

Gallstone disease risk factors

Answer 3

Fat
Female
Fertile
Forty
Family history

Question 4

Define Biliary colic

Answer 4

The pain experienced when the gallbladder neck becomes impacted by a gallstone

Question 5

Biliary colic Sx

Answer 5

• sudden, dull, colicky pain
• RUQ
• usually triggered by a fatty meal

Question 6

Cholecystitis special test

Answer 6

Murphy’s sign

Question 7

What is the Murphy’s sign

Answer 7

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

Question 8

1st line imaging Ix for cholecystitis

Answer 8

Abdo USS

Question 9

Abdo USS features for cholecystits

Answer 9

1. The presence of gallstones or sludge
2. Gallbladder wall thickness (if thick walled, then inflammation is likely)
3. Bile duct dilatation (indicates a possible stone in the distal bile ducts)

Question 10

what imaging Ix is used when abdo USS is inconclusive

Answer 10

Magnetic Resonance Cholangiopancreatography (MRCP)

Question 11

how does pregnancy and COCP increase risk of gallstone formation

Answer 11

Oestrogen causes more cholesterol to be secreted into bile

Question 12

Acute cholecystitis Sx

Answer 12

• RUQ or Epigatric pain
• Fever
• Lethergy

Question 13

Acute cholecystitis clinical signs

Answer 13

• Positive Murphy’s sign
• RUQ tenderness

Question 14

Abdo examination indication of gallbladder perforation

Answer 14

Guarding

Question 15

Define Gallbladder Empyema

Answer 15

A gallbladder empyema is when the gallbladder becomes filled with pus

Question 16

Gallbladder Empyema Tx

Answer 16

1. Laparoscopic cholecystectomy
2. Percutaneous cholecystostomy

Question 17

Acute cholecystitis Mx

Answer 17

1. IV Abx (Co-amox / Metronidazole)
2. Analgesia
3. Antiemetics

Question 18

Time frame for laparoscopic cholecystectomy of Acute cholecystitis

Answer 18

Within 1 week of presentation

Question 19

Acute cholecystitis not fit for surgery intervention

Answer 19

Percutaneous cholecystostomy

Question 20

Medical term for gallbladder stones

Answer 20

cholelithiasis

Question 21

Define Gallbladder mucocoele

Answer 21

a condition where the gallbladder becomes distended and filled with sterile mucus due to obstruction of the cystic duct.

Question 22

Gallbladder mucocoele Sx

Answer 22

• RUQ pain - dull, persistent, worse post meal
• N + V
• Fever

Question 23

Gallbladder mucocoele clinical signs

Answer 23

• Palpable RUQ mass - Distended, non-tender gallbladder
• Septic - hypotension, Tachycardic, Tachypnoeic
• Fever

Question 24

Gallbladder mucocoele USS features

Answer 24

• Distended, thin-walled gallbladder with anechoic (no sound) content.
• No gallstones (unlike typical cholecystitis)

Question 25

Definitice Tx for gallbladder mucocoele

Answer 25

Cholecystectomy

Question 26

**untreated** Gallbladder mucocoele complications

Answer 26

- **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

Question 27

Medical term for CBD stones

Answer 27

Choledocholithiasis

Question 28

Laparoscopic cholestectomy complications

Answer 28

- Bleeding - damage to bile ducts - damage to bowel, blood vessels and organs - VTE - Stones left in bile duct - Anaesthetic risks - **Post-cholestectomy syndrome**

Question 29

Post-cholestectomy syndrome Sx

Answer 29

- diarrhoea - indigestion - RUQ pain - Nausea - Flactulence - intolerance of fatty food