Acute Cholecystitis

What is it

A SURGICAL EMERGENCY 🚩. Inflammation of the Gallbladder. Most often caused by gallstones. Acute Cholecystitis develops in 1-3% of patients with symptomatic gallstones.

Diagnosis

1) Constant pain in the RUQ (>12 hours)
 
2) Tenderness in the RUQ (with or without Murphy's sign and with or without a palpable mass
 
3) Inflammatory Response (Fever, raised WCC + CRP)

Investigations

US: 
 
--> Pericholecystic Fluid (Fluid around the gallbladder), distended gallbladder, oedematous gallbladder wall and gallstones
 
--> Murphy's sign may be elicited on US examination
 
Gold Standard (When Diagnostically Challenging): 
 
--> Biliary scintigraphy (hydroxyiminodiacetic acid (HIDA) scan)

Diagnosis

Diagnosis: US + Clinical Features

Management

First Line Treatment: IV FLuids, Analgesia, NBM
 
If systemic signs or no improvement after 12-24 hours: Add IV Abx
 
Surgery (Cholecystectomy) within 24-48 hurs of admission (early) > delayed or interval surgery
 
Percutaneous Cholecystotomy is an alternative to cholecystectomy for very ill patients or those unfit for surgery
 
20% of cases, emergency surgery is needed to treat gangrenous cholecystitis or gallbladder perforation

Link: Reference Paper (opens in a new tab)

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