Cholecystitis Flashcards
What is cholecystitis?
Acute or chronic inflammation of the gallbladder usually due to cholelithiasis (gall stones)
Most common organism resulting in infection (if obstruction)?
(1) E. Coli
+ Klebsiella, enterococcis
Key features of acute cholecystitis?
(1) RUQ/epigastric pain - radiates to right shoulder tip
(2) N&V
(3) Fever
- -> Murphy’s sign
- -> RUQ tender
Difference to cholangitis/charcots triad?
NO JAUNDICE –> unless bile duct obstruction
Diagnosis?
Clinical + USS abdomen
Supportive management?
nil-by-mouth
IV fluids
Antibiotics - IV cefuroxime
Analgesia
Definitive management?
Laparoscopic cholecystectomy (likely to recur) within 1 week of diagnosis (for acute)
When would you perform open cholecystectomy?
- acutely unwell
- Gallbladder mass present
- significant inflammation/bleeding
- prev. abdo surgery
- pregnancy
What’s the McMurphey’s sign?
Inspiratory arrest upon palpation of RUQ
What is biliary colic caused by?
Gallstones passing through biliary tree
Risk factors for biliary colic/gallstones?
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
Presentation of biliary colic/gallstones?
Colicky (recurrent) RUQ pain
- worse after eating + fatty foods
- may radiate to right shoulder tip/inter scapular region
N&V
Investigation of biliary colic/gallstones?
US
Management of biliary colic/gallstones?
Laparoscopic cholecystectomy
