Cholecystitis

Question 1

what is cholecystitis

Answer 1

inflammation of the gallbladder

Question 2

aetiology/ causes of cholecystitis

Answer 2

gallstones obstruct the common bile duct or the neck of the gall bladder and therefore lead to inflammation. there are different types of stones.

Question 3

what are the three different types of gallstones

Answer 3

mixed stones (80%). pure cholesterol stones (10%) and pigment stones (10%)

Question 4

mixed stones composition

Answer 4

cholesterol, calcium bilirubinate, phosphate and protein

Question 5

why do pigment stones form

Answer 5

they are black stones formed from calcium bilirubinate. this is due to high bilirubin levels due to haemolysis

Question 6

less common causes of cholecystitis

Answer 6

bile inspissation and bile stasis

Question 7

epidemiology of cholecystitis

Answer 7

very common, UK prevalence is 10%, 3x more common among females

Question 8

risk factors for cholecystitis

Answer 8

female, fair, forty, fertile and fat

increasing age, low fibre diet, family Hx, diabetes mellitus, physically inactive and drugs

Question 9

risk factors for pigment stones forming

Answer 9

haemolytic disorders such as Sickle cell anaemia

Question 10

presenting symptoms

Answer 10

RUQ pain, epigastric tenderness, fever, tachycardia, guarding and rebound tenderness, palpable mass

Question 11

physical examination findings

Answer 11

guarding and rebound tenderness, Murphys sign and RUQ pain

Question 12

Murphy’s sign

Answer 12

test for cholecystitis.
patient exhales and takes a deep breath in; upon inspiration the examiner palpates the RUQ of the patient. as the gallbladder hits the hand of the examiner, the patient will flinch from pain. this is a positive Murphys sign

Question 13

investigations

Answer 13

bloods; FBC, LFT’s, blood cultures and amylase

ultrasound

Question 14

interpret blood findings in someone with cholecystitis

Answer 14

FBC; high WCC and high CRP
LFT’s; high ALP and GGT
amylase- to eliminate pancreatitis

Question 15

ultrasound findings in someone with cholecystitis

Answer 15

thickening of the gall bladder wall, dilating of the common bile duct and gallstones will be seen

Question 16

management

Answer 16

conservative vs medical vs surgical

Question 17

medical management of cholecystitis

Answer 17

analgesia, fluid resuscitation (IVF), IV ABx if infected, nil by mouth, antiemetics, if obstruction do ERCP or removal of stone by percutaneous route (percutaneous cholecystectomy)

Question 18

conservative management

Answer 18

low fat diet

Question 19

surgical management

Answer 19

laparoscopic cholecystectomy

Question 20

complications if gallstones are inside gall bladder

Answer 20

Biliary colic
Cholecystitis
Gallbladder empyema
Gallbladder cancer (RARE)

Question 21

complications if gall stones outside the gallbladder

Answer 21

Obstructive jaundice  
Pancreatitis  
Ascending cholangitis  
Cholecystoduodenal fistula  
Gallstone ileus  
Bouveret syndrome (gallstones cause gastric outlet obstruction)  
Mirizzi syndrome

Question 22

complications of cholecystectomy surgery

Answer 22

post-cholecystectomy syndrome ; RUQ pain, nausea, vomitting, dyspepsia
bleeding
infection
post-site hernia

Question 23

prognosis?

Answer 23

Gallstones do NOT cause symptoms most of the time

Surgery offers an excellent chance of cure if they were to become symptomatic