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