Cholecystitis

In acute cholecystitis, the stone blocks the neck of the gallbladder or cystic duct for a long period of time, rubbing against and damaging the mucosal lining, therefore causing inflammation.

Acute acalculous cholecystitis is acute cholecystitis w/o gallstones, and is caused by ischaemia. This occurs in major trauma/burns as the cystic artery has no collateral circulation, therefore no way to stop ischaemia if it became less perfused.

Chronic cholecystitis is where there are recurrent episodes of biliary colic and acute cholecystitis, leading to chronic inflammation with fibrotic scars. This makes the gallbladder thicken and shrink.

Patients present with:

• RUQ/Eepigastric pain (radiating to right shoulder tip if diaphragm is irritated), radiating to the back and relieved by sitting forward

• Fever

• N+V

• Murphy’s +ve

Investigations:

• USS - Thickened gallbladder, pericholecystic fluid

• MRCP

Management:

• Supportive with NBM, IVF, Analgesia, Abx

• Cholecystectomy

• Cholecystostomy to drain gallbladder if acutely unwell, with a plan for a delayed cholecystectomy