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Finals: Surgery > Cholecystitis > Flashcards

Cholecystitis Flashcards

1
Q

Acute cholecystitis refers to?

A

Inflammation of the gallbladder

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2
Q

What is the most common cause of acute cholecystitis

A

Gallstones (calculous cholecystitis) either blocking the neck of the gallbladder or the cystic duct

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3
Q

Define Calculous cholecystitis

A

Acute cholecystitis in the presence of gallstones

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4
Q

Define Acalculous cholecystitis

A

Acute cholecystitis in the absence of gallstones. They are relatively rare.

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5
Q

What are the two main presenting symptoms of acute cholecystitis

A
  • Constant pain in the right upper quadrant or epigastrium, which may radiate to the right shoulder
  • Signs of inflammation e.g. fever, lethargy.
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6
Q

Describe the pain patients experience with acute cholecystitis

A

Constant pain in the right upper quadrant or epigastrium, which may radiate to the right shoulder

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7
Q

Murphy’s sign is indicative of which condition

A

Cholecystitis i.e. inflammation of the gallbladder

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8
Q

Name some of the symptoms of acute cholecystitis

A
  • Right upper quadrant or epigastric pain
  • Nausea and/or vomiting
  • Fevers
  • Lethargy
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9
Q

Name some of the signs of acute cholecystitis

A
  • Murphy’s sign
  • RUQ / epigastric tenderness
  • RUQ / epigastric guarding
  • Pyrexia
  • Tachycardia (fast heart rate)
  • Tachypnoea (raised respiratory rate)
  • Hypotension – suggestive of sepsis
  • Guarding – suggestive of gallbladder perforation
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10
Q

Define Murphy’s sign

A

Acute Pain in the RUQ during inspiration

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11
Q

Describe the mechanism behind the pain associated with Murphy’s sign

A

Pain is present as the gallbladder moves downwards during inspiration and comes in contact with the pressure and thus this stimulates the inflamed gallbladder

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12
Q

What is the gold standard investigation for acute cholecystitis

A

Trans-abdominal ultrasound scan

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13
Q

CRP and WCC will be ____ in acute cholecystitis:

a) raised
b) lowered
c) normal

A

a) raised

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14
Q

Which LFT blood test is likely to be raised in acute cholecystitis

A

ALP

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15
Q

A raised ALP is indicative of?

A

Ductal occlusion

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16
Q

What is the 1st line imaging modality for acute cholecystitis

A

Ultrasound

If results from US scans are inconclusive, further imaging options are available

17
Q

What is the gold standard imaging modality for gallstones

A

Magnetic resonance cholangiopancreatography (MRCP)

18
Q

What are the 3 signs of acute cholecystitis on ultrasound

A
  • Thickened gallbladder wall
  • Stones or sludge in gallbladder
  • Fluid around the gallbladder
19
Q

What is the aim of management for acute cholecystitis

A

Aim of management is to treat the infection and symptoms and prevent recurrence (with laparoscopic cholecystectomy)

20
Q

How would symptoms be managed in acute cholecystitis

A
  • IV antibiotics – as per local guidelines
  • Fluids – resuscitation and maintenance fluids are required.
  • Analgesia – + antiemetics
  • Nil by mouth – in preparation for surgery
    • NG tube – if required for vomiting
21
Q

What is the difference between hot and interval laparoscopic cholecystectomy:

A

‘Hot’ laparoscopic cholecystectomy: surgery is arranged within 72 hours (or at some centres up to one week) of the onset of symptoms. Most common

Interval laparoscopic cholecystectomy: removal of a diseased gallbladder after drainage for acute infection

22
Q

Name some of the Complications of cholecystectomy

A
  • Bleeding, infection, pain, and scars
  • Damage to the bile duct including leakage and strictures
  • Stones left in the bile duct
  • Damage to the bowel, blood vessels or other organs
  • Anaesthetic risks
  • Venous thromboembolism (deep vein thrombosis or pulmonary embolism)
  • Post-cholecystectomy syndrome
23
Q

For those not fit for surgery and not responding to antibiotics what can be performed to drain the infection

A

Percutaneous cholecystostomy

Once recovered, patients are often discharged with this drain in situ until definitive management can be arranged.

24
Q

Any patient readmitted with RUQ pain post-cholecystectomy is it important to exclude?

A

A retained CBD stone post-operatively

25
Q

Name some of the Complications of Acute Cholecystitis

A
  • Recurrent cholecystitis
  • Cholecystoduodenal fistula – fistula between the gallbladder wall and the small bowel
  • Bouveret’s Syndrome – gallstone impacting the proximal duodenum causing a gastric outlet obstruction
  • Gallstone Ileus – gallstone impacting the terminal ileum (narrowest part of the small bowel) causing a small bowel obstruction
  • Sepsis
  • Gallbladder empyema
  • Gangrenous gallbladder
  • Perforation
26
Q

Define Cholecystoduodenal fistula

A

Fistula between the gallbladder wall and the small bowel

27
Q

Define Bouveret’s Syndrome

A

Occurs when a gallstone impacting the proximal duodenum causing a gastric outlet obstruction

28
Q

Define Gallstone Ileus

A

Gallstone impacting the terminal ileum (narrowest part of the small bowel) causing a small bowel obstruction

29
Q

What is the name give to the right subcostal incision in open cholecystectomy

A

Kocher incision

Finals: Surgery (10 decks)

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