Cholecystitis

Acute cholecystitis refers to the acute inflammation of the gallbladder, with 90% of cases being secondary to gallstones.

Causes/Factors

Gallstone blockage

• Age
• Obesity
• Smoking
• low fibre intake

Symptoms

	RUQ Pain	Fever/$\uparrow$WCC	Jaundice
Biliary colic	$✓$	X	X
Acute cholecystitis	$✓$	$✓$	X
Acute cholangitis	$✓$	$✓$	$✓$

• Worsening of pain/symptoms after eating fatty food
• nausea, vomiting
• RUQ pain - radiating round side / to back

Signs

• Murphy’s test positive - RUQ pain which may radiate worse on inspiration

Diagnostic Tests

• WCC, FBC, CRP, LFTs

• USS (and/or CT/MRI abdo)

• magnetic resonance cholangiopancreatography (MRCP)

• endoscopic ultrasound (EUS)

Management

Patients are usually systemically unwell and require hospital admission for oral/IV antibiotics and surgery within 7 days of diagnosis

• antibiotics
• Laparoscopic cholecystectomy

Complications/red Flags

If in the gallbladder/cystic duct:

• Biliary colic
• Acute and chronic cholecystitis
• Mucocele
• Empyema
• Carcinoma
• Mirizzi syndrome

In the bile ducts

• Obstructive Jaundice
• Acute cholangitis
• Pancreatitis