Acute Cholecystitis

Question 1

What is acute cholecystitis?

Answer 1

It is is defined as a condition in which there is inflammation of the gallbladder

Question 2

What are the three risk factors associated with acute cholecystitis?

Answer 2

Gallstones

Infection

Immunosuppression

Question 3

What is the most common risk factor associated with acute cholecystitis?

Answer 3

Gallstones

Question 4

What are the two infections associated with acute cholecystitis?

Answer 4

Cryptosporidium

Cytomegalovirus

Question 5

What are the nine clincial features of acute cholecystitis?

Answer 5

Fever > 38C

Nausea & Vomiting

Right Upper Quadrant Pain

Shoulder Pain

Murphy’s Sign

Boas’ Sign

Tachycardia

Tachypnoea

Hypertension

Question 6

What is Murphy’s sign?

Answer 6

It is defined as inspiration arrest on palpation of the right upper quadrant

Question 7

What is Boas sign?

Answer 7

It refers to hyperasthesia beneath the right scapula

It occurs due to abdominal wall innervation of this region from the spinal roots that lie at this level

Question 8

What are the three investigations used to diagnose acute cholecystitis?

Answer 8

Blood Tests

Ultrasound Scan

Hepatobiliary Iminodiacetic Acid (HIDA) Scan

Question 9

What are the seven blood test results indicative of acute cholecystitis?

Answer 9

Increased WCC Level

Increased CRP Lebel

Normal Bilirubin Level

Normal ALT Level

Normal AST Level

Normal ALP Level

Normal GGT Level

Question 10

What differential diagnosis is indicated when liver function tests are deranged?

Answer 10

Mirizzi’s Syndrome

Question 11

When are ultrasound scans used to diagnose acute cholecystitis?

Answer 11

It is the first line investigation used to diagnose acute cholecystitis

Question 12

What are the four features of acute cholecystitis on ultrasound scan?

Answer 12

Sonographic Murphy’s Sign

Gallbladder Wall Thickening > 3mm

Gallbladder Distention

Pericholecystic Fluid

Question 13

When are HIDA scans used to diagnose acute cholecystitis?

Answer 13

It is the second line investigation used to diagnose acute cholecystitis

Question 14

What is a HIDA scan?

Answer 14

This involves IV injection of technetium labelled HIDA, which is taken up selectively by hepatocytes and excreted into bile

Question 15

What is a feature of acute cholecystitis on HIDA scans? Explain

Answer 15

It is indicated by non-visualisation of the gallbladder four hours following injection

This is due to the fact that there is cystic duct obstruction secondary to oedema associated with inflammation or an obstructing gallstone

Question 16

What is the pharmacological management option of acute cholecystitis?

Answer 16

IV Beta-Lactam Antibiotics

Question 17

When are IV antibiotics used to manage acute cholecystitis?

Answer 17

They are used to manage acute cholecystitis related to infection

Question 18

Name two antibiotics used to manage acute cholecystitis

Answer 18

Tazobactam

Sulbactam

Question 19

What is the surgical management option of acute cholecystitis?

Answer 19

Laparoscopic Cholecystectomy

Question 20

When is laparoscopic cholecystectomy used to manage acute cholecystitis?

Answer 20

It is recommended in all cases, within one week of diagnosis

Question 21

When is laparoscopic cholecystectomy used to manage acute cholecystitis?

Answer 21

It is recommended in all cases, within one week of diagnosis

Question 22

What is laparoscopic cholecystectomy?

Answer 22

It involves laparoscopic removal of the gallbladder

Question 23

How do we differentiate between ascending cholangitis, acute cholecystitis and biliary colic?

Answer 23

In ascending cholangitis, individuals present with RUQ pain, fever and jaundice - with significant systemic features

In acute cholecystitis, individuals present with RUQ pain and fever - however systemic features are limited

In biliary colic, individuals present with RUQ pain, with absence of systemic features