Cholecystitis Flashcards
1
Q
Outline the pathogenesis of cholecystitis
A
- Gallstone impaction in the gallbladder neck/cystic duct causes PG mediated inflammation and increase in gallbladder pressure
- Secondary bacterial infection can occur
2
Q
Who is at risk of developing cholecystitis?
A
- People with known gallstones
- Severe illness (trauma, shock/dehydration)
- TPN (decreased motility of gallbladder)
3
Q
What are likely signs and symptoms on presentation in patients with cholecystitis?
A
- Previous biliary pain
- RUQ pain constant increasing over >30min
- Often postprandial
- Anorexia
- Nausea/vomiting
- Murphy’s sign
- ?Palpable RUQ mass
- ?Fever (likely more complicated)
- ?Referred pain to shoulder
4
Q
What investigations might you order in someone suspected of having cholecystitis?
A
- FBC (elevated WBCs)
- CRP
- LFTs (increased ALP, GGT)
- US abdo
5
Q
How might you manage someone with cholecystitis?
A
- Supportive care - fluids
- Antibiotics - if infection suspected. Cefuroxime
- NSAID - reduce PG-related inflammation. Diclofenac
- Cholecystectomy
