Chapter 53: Biliary Tract- Acute Cholecystitis

Question 1

What is the pathogenesis of acute cholecystitis?

Answer 1

• Obstruction of cystic duct leads to inflammation of the gallbladder
  
  • ≈95% of cases result from calculi
  • ≈5% from acalculous obstruction

Question 2

What are the risk factors?

Answer 2

Gallstones

Question 3

What are the signs and symptoms?

Answer 3

• Unrelenting RUQ pain or tenderness
• Fever Nausea/vomiting
• Painful palpable gallbladder in 33%
• Positive Murphy’s sign
• Right subscapular pain (referred)
• Epigastric discomfort (referred)

Question 4

What is Murphy’s sign?

Answer 4

Acute pain and inspiratory arrest elicited by palpation of the RUQ during inspiration

Question 5

What are the complications of acute cholecystitis?

Answer 5

• Abscess
• Perforation
• Choledocholithiasis
• Cholecystenteric fistula formation
• Gallstone ileus

Question 6

What lab results are associated with acute cholecystitis?

Answer 6

• Increased WBC
• may have:
  
  • Slight elevation in alkaline phosphatase
  • LFTs
  • Slight elevation in amylase
  • total bilirubin

Question 7

What is the diagnostic test of choice for acute cholecystitis?

Answer 7

Ultrasound

Question 8

What are the signs of acute cholecystitis on ultrasound?

Answer 8

• Thickened gallbladder wall (>3 mm)
• Pericholecystic fluid
• Distended gallbladder
• Gallstones present/cystic duct stone
• Sonographic Murphy’s sign (pain on inspiration after placement of ultrasoundprobe over gallbladder)

Question 9

What is the difference between acute cholecystitis and biliary colic?

Answer 9

• Biliary colic has temporary pain
• acute cholecystitis has
  
  • pain that does not resolve
  • usually with elevated WBCs
  • fever, and signs of acute inflammation on U/S

Question 10

What is the treatment of acute cholecystitis?

Answer 10

VFs, antibiotics, and early cholecystectomy