Cholecystitis Accordion Q&A Notes
Cholecystitis Active Recall Accordion Q&A Revision Notes
(Question and Answer Active Recall Accordion Notes – please click the arrow to display the answer to the revision questions)
Definition and Aetiology of Cholecystitis
• Inflammation of the gallbladder
• Primary cause: Gallstone blockage of the cystic duct
• Other causes: Tumours, infections, parasites, or gallbladder trauma
Risk Factors for Cholecystitis
• Obesity
• Female gender
• Older age
• History of gallstones
• Rapid weight loss
• Fasting
• Pregnancy
• Sedentary lifestyle
• Certain medications (e.g., hormone replacement therapy)
• Medical conditions: Diabetes, cirrhosis, Crohn’s disease
Pathophysiology and Complications of Cholecystitis
• Obstruction of the cystic duct leads to gallbladder bile buildup
• Consequences: Inflammation, distension, infection
• Complications: Abscesses, gangrene, perforation, peritonitis, sepsis
Clinical Presentation of Cholecystitis
• Acute: Severe RUQ pain, fever, nausea, vomiting
• Chronic: Milder, intermittent pain and indigestion
• Positive if pain and cessation of inspiration when the gallbladder touches fingers during palpation
• Palpable mass
• RUQ pain radiating to back or right shoulder
• Anorexia
• Jaundice (in 10% of cases)
Differential Diagnosis of Cholecystitis
• Biliary colic
• Acute pancreatitis
• Peptic ulcer
• Gastro-oesophageal reflux disease (GORD)
• Appendicitis
Epidemiology of Cholecystitis
• 10-15% of UK adults develop gallstones; a subset may develop cholecystitis
• Higher prevalence in women
• Incidence increases with age
Investigations for Cholecystitis
• Observations: Respiratory rate, heart rate, blood pressure, temperature, oxygen saturation
• Blood tests: Full Blood Count for leukocytosis, CRP for inflammation, LFTs for elevated bilirubin, ALT, ALP, GGT
• Amylase/Lipase to exclude pancreatitis
• Abdominal ultrasound for gallbladder wall thickening, distension, and gallstones
• Abdominal CT for suspected sepsis or perforation
• HIDA cholescintigraphy for blocked cystic duct if other imaging is inconclusive
• Gallbladder wall thickening (>3 mm)
• Presence of gallstones
• Pericholecystic fluid
Management of Cholecystitis
• Hospitalization with IV antibiotics
• Laparoscopic cholecystectomy for definitive treatment
• Dietary changes avoiding fatty foods
• Pain management: Paracetamol, NSAIDs, opioids
• Nausea: Anti-emetic (e.g., cyclizine)
• Infection: IV antibiotics
• Hydration: IV fluids
• Nil-by-mouth to rest gallbladder
• Percutaneous cholecystotomy for patients unfit for surgery
• Laparoscopic cholecystectomy within a week or delayed surgery 6 weeks post-symptom resolution
Prognosis and Complications of Cholecystitis
• Favorable prognosis with treatment
• Cholecystectomy provides symptom relief and low recurrence risk
• Gangrene, perforation, abscesses
• Sepsis
• Development of common bile duct stones
• Mirizzi’s syndrome, gallbladder empyema
• Laparoscopic cholecystectomy
• Percutaneous drainage if surgery is not feasible