Acute Cholecystitis

Question 1

What is acute cholecystitis?

Answer 1

Acute inflammation of the gallbladder

Question 2

What is the pathophysiology of acute cholecystitis?

Answer 2

Develops secondary to gallstones in 90% of cases (most common complication - calculous)

Acalculous cholecystitis (10%) - typically seen in hospitalised and severely ill patients (gallbladder stasis, hypoperfusion, infection)

Question 3

What are the features of acute cholecystitis? (4)

Answer 3

1. Right upper quadrant pain - may radiate to right shoulder
2. Fever and signs of systemic upset
3. Murphy’s sign on examination: inspiratory arrest upon palpation of the right upper quadrant
4. Liver function test typically normal unless there is Mirizzi syndrome (extrinsic compression of the CBD)

(May have abdominal bulge)
Loss of appetitie

Question 4

What are the investigations for acute cholecystitis?

Answer 4

Ultrasound 1st line

Cholescintigraphy (HIDA scan) if diagnosis remains unclear

Question 5

What is the treatment of acute cholesystitis?

Answer 5

Fasting to take the strain off the gallbladder
Intravenous antibiotics
Early laparoscopic cholesystectomy to prevent recurrence within 1 week of diagnosis.

Question 6

What is a complication of severe infection in acute cholesystitis?

Answer 6

Gallbladder abscess
Gangreous cholecystitis

May require surgical drainage
Can rupture and lead to peritonitis

Question 7

Why is jaundice not seen?

Answer 7

No obstruction so no jaundice or deranged LFTs

Deranged LFTs may indicate Mirizzi syndrome - extrinsic compression off the common bile duct