Cholecystitis

Question 1

What is acute cholecystitis mainly caused by?

What are other causes?

Answer 1

90% are due to gallstones

10% are acalculous, more seen in patients on TPN or long term fasting, e.g. in ICU. Also seen in immunocompromised patients

Question 2

What are the features of Acute Cholecystitis?

Answer 2

Constant RUQ, may radiate to right shoulder.
+ve Murphy’s sign

Question 3

Are LFTs normal in Acute Cholecystitis?

Answer 3

Yes
If abnormal -> consider Mirizzi’s syndrome

Question 4

What is the gold standard investigation for Acute Cholecystitis?

What are alternative scans?

Answer 4

Abdominal US - gold standard.

CT with contrast - porcelain gallbladder, MRI

Question 5

What is the management of Acute Cholecystitis?

Answer 5

Diclofenac
IV abx
Lap chole within 1 week

Question 6

What is Murphy’s sign?

Answer 6

Cessation of inspiration on palpation of RUQ

Question 7

How big is a normal bile duct?

Answer 7

Between 4-7mm

Question 8

What signs on an ultrasound are found in acute cholecystitis?

Answer 8

Thickened gallbladder wall
Fluid around gallbladder
Stones or sludge in gallbladder