Cholecystitis
Reviewed and revised 5/5/12
OVERVIEW
- cholecystitis = inflammation of the gall bladder
- causes: mechanical, chemical and infectious -> mucosal injury
- complications: pancreatitis, ascending cholangitis, gall bladder empyema, gangrene
- bacteria: enterobacteriaceae (E. coli, Klebsiella), enterococci, bacteroides, clostridium, group D strep, staph
CLINICAL FEATURES
Symptoms
- pain: RUQ and epigastric
- radiation to left upper back
- persists beyond 6 hours
- often between 2100-0400
- N+V
Signs
- dull, poorly localised -> sharp, well localised mid-upper abdominal pain
Risk factors
- increased age
- female
- parity
- obesity
- diabetes mellitus
- profound weight loss
- fasting
- cystic fibrosis
- malabsorption syndromes
- familial
- various medication (oral contraceptive pill and clofibrate)
INVESTIGATIONS
Bedside
- ECG: r/o MI
Laboratory
- WCC, bilirubin and LFTs often normal
- chronic anaemia (haemolysis)
- amylase (r/o pancreatitis)
- BHCG
Imaging
- AXR: 15% of stone visible
- CXR: r/o RLL pneumonia
- U/S: 94% sensitivity and 78% specificity (better than CT)
MANAGEMENT
- IVF
- NBM
- opioid analgesia
- antiemetics
- antibiotics (e.g. non-septic: ceftriaxone, septic: triple antibiotics)
- cholecystectomy
References
- Top 100 Ultrasounds – Ultrasound Case 078
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC