Cholecystitis

Question 1

What is cholecystitis?

Answer 1

Acute or chronic inflammation of the gallbladder usually due to cholelithiasis (gall stones)

Question 2

Most common organism resulting in infection (if obstruction)?

Answer 2

(1) E. Coli

+ Klebsiella, enterococcis

Question 3

Key features of acute cholecystitis?

Answer 3

(1) RUQ/epigastric pain - radiates to right shoulder tip
(2) N&V
(3) Fever
- -> Murphy’s sign
- -> RUQ tender

Question 4

Difference to cholangitis/charcots triad?

Answer 4

NO JAUNDICE –> unless bile duct obstruction

Question 5

Diagnosis?

Answer 5

Clinical + USS abdomen

Question 6

Supportive management?

Answer 6

nil-by-mouth
IV fluids
Antibiotics - IV cefuroxime
Analgesia

Question 7

Definitive management?

Answer 7

Laparoscopic cholecystectomy (likely to recur) within 1 week of diagnosis (for acute)

Question 8

When would you perform open cholecystectomy?

Answer 8

• acutely unwell
• Gallbladder mass present
• significant inflammation/bleeding
• prev. abdo surgery
• pregnancy

Question 9

What’s the McMurphey’s sign?

Answer 9

Inspiratory arrest upon palpation of RUQ

Question 10

What is biliary colic caused by?

Answer 10

Gallstones passing through biliary tree

Question 11

Risk factors for biliary colic/gallstones?

Answer 11

4 F’s:

• Fat: obesity (increased cholesterol)
• Female: 2-3x more common (increased oestrogen)
• Fertile: pregnancy
• Forty

Others:
1 - Diabetes mellitus
2 - Crohn's
3 - rapid weight loss
4 - drugs e.g. COCP, fibrates

Question 12

Presentation of biliary colic/gallstones?

Answer 12

Colicky (recurrent) RUQ pain
- worse after eating + fatty foods
- may radiate to right shoulder tip/inter scapular region
N&V

Question 13

Investigation of biliary colic/gallstones?

Answer 13

US

Question 14

Management of biliary colic/gallstones?

Answer 14

Laparoscopic cholecystectomy