“Inflammation of the gallbladder”

Risk Factors
  • Risk factors for developing gallstones:
    • Obesity
    • Female
    • Increasing age
    • Diabetes mellitus
    • Higher levels of serum triglycerides and lower levels of HDL
    • Smoking
  • Risk factors for acalculous cholecystitis:
    • Trauma
    • Burns
    • Sepsis
    • Immobility
    • Acute renal failure
    • Total parenteral nutrition
    • Narcotic analgesia
Aetiology
  • Gallstones (90-95% of cases)
  • Acalculous cholecystitis- no gallstones (5% of cases)
Pathophysiology
  1. Gallstone impacted in the neck of the gallbladder
  2. Obstruction of the cystic duct
  3. Inflammation of the gallbladder
  • Acalculous cholecystitis
    1. Bile thickening (related to dehydration) or stasis (due to trauma)
    2. Blockage of the cystic duct
    3. Inflammation of the gallbladder
Clinical Presentation
  • Symptoms:
    • Sudden onset, constant, severe RUQ pain
    • Nausea and vomiting
    • Bloating
  • Signs:
    • Guarding
    • Murphy’s sign
    • Fevers
    • Tachycardia
    • Hypotension
    • RUQ palpable mass (distended gallbladder or inflammatory mass around inflamed gallbladder
Investigations
  • Bloods:
    • FBC
    • U&Es
    • CRP
    • LFTs- may have raised bilirubin and ALP
    • Amylase
    • Pregnancy test for any woman of childbearing age
  • Imaging:
    • Ultrasound
    • CT
    • Magnetic resonance cholangiopancreatography (MRCP
  • Special:
    • Endoscopic retrograde cholangiopancreatography (ERCP)
Management
  • Initial management should follow an ABC approach
  • Conservative: n/a
  • Medical:
    • Analgesia
    • IV fluids
    • Antibiotics
  • Surgical:
    • Laparoscopic cholecystectomy
Complications
  • Necrosis of the gallbladder wall (gangrenous cholecystitis)
  • Perforation of the gallbladder
  • Biliary peritonitis
  • Peri-cholecystic abscess
  • A fistula between the gallbladder and the duodenum Mirizzi’s syndrome- stone in gallbladder presses on the bile duct causing jaundice

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