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Cholecystitis

From Mediwikis

Acute Cholecystitis occurs when a gallstone becomes lodged in the outlet of the gallbladder. This causes the gall bladder to increase secretions, creating distension and inflammation.


Murphys Sign, courtesy of AllAccessMedicine.

Signs and Symptoms

  • Progressive epigastric/Right Upper Quadrant pain (referred to the right shoulder tip by the C3,4,5 dermatome)
  • Vomiting
  • Fever
  • Positive Murphy's sign (sharp pain upon inspiration as examiner palpates the right hypochondrium, in the region of the gall bladder).
  • Features of obstructive jaundice

Complications

Obstructive jaundice

Investigations:

  • LFTs: Bilirubin, ALP, GGT
    • If obstructive jaundice is present, bilirubin, ALP and GGT may be raised.
  • Abdominal USS
    • Thickened gall bladder wall, gallstones visible
  • ERCP or MRCP

Management:

  • Nil by mouth, IV fluids, opioid analgesia
  • IV antibiotics-
    • Cefalosporins, Piperacillin/Tazobactam
  • Cholecystectomy