Pathophysiology
Acute cholecystitis refers to inflammation of the gallbladder caused by a gallstone blocking the cystic duct (95% of cases).
In 5% of cases, acute cholecystitis can be caused without the presence of gallstones. This is known as acalculous cholecystitis.
Epidemiology
Risk factors include the 5 F’s:
- Female
- Fat
- Fertile
- Forty
- Family history
Clinical Features
Symptoms:
- Right upper quadrant (RUQ) pain
- Shoulder tip pain (referred)
- Fever
- Nausea
- Vomiting
Signs:
- ↑ Temp
↑ HR
- ↑ RR
- RUQ tenderness
- Murphy’s sign +ve
Investigations
- BLOODS
- ↑ White cell count (WCC)
- ↑ C-reactive Protein (CRP)
- ↑ AST
- ↑ ALT
- IMAGING
- USS Abdomen
- Gallstones
- Thickened gallbladder wall
- Pericholecystic fluid
- USS Abdomen
Management
- Disposition:
- Inpatient (Emergency Department / General Surgical Ward)
- Conservative:
- Nil by mouth (NBM)
- IV fluids
- IV antibiotics
- Analgesia
- Surgical Management:
- Laparoscopic cholecystectomy (can occur within 72 hours of admission. Can also be done 6-8 weeks after acute episode)
