Cholecystitis Types

Study Notes

Prolonged gallbladder outlet obstruction leading to inflammation due to concentrated bile
May be complicated by infection, pus (empyema), or mucus (mucocele)
Often a history of previous biliary colic
RUQ/epigastric pain that becomes more severe, constant, and localized after a day or two
Associated fever, ↑ WCC, may be rigors and other features of sepsis
Tenderness and guarding in the RUQ on examination
Murphy's sign positive

Repeated episodes of inflammation resulting in chronic fibrosis and thickening of the entire gallbladder wall
Recurrent episodes of pain with or without fever

Inflammatory markers (WCC, CRP) usually elevated in acute cholecystitis, cholangitis, and pancreatitis
LFTs may show an obstructed picture
Serial measurements of LFTs should be taken if obstructive jaundice is present
Ultrasound scan (USS) used to visualise the gallbladder and biliary tree
Plain abdominal x-ray useful in gallstone ileus, showing evidence of small bowel obstruction, often with pneumobilia
MRCP allows better visualisation of the biliary tree and demonstrates any gallstones within the CBD that may be causing obstruction
ERCP is diagnostic for biliary tree dilatation and CBD stones, and is used therapeutically to remove obstructing CBD stones, insert stents, and perform sphincterotomy

Antibiotics required in patients with acute cholecystitis, cholangitis, and acute severe pancreatitis
Vitamin K used to correct coagulopathy caused by obstructive jaundice
ERCP may be used therapeutically in the presence of CBD obstruction
Percutaneous transhepatic cholangiography (PTC) used in patients with severe biliary obstruction and sepsis who are unsuitable for ERCP or where it has been unsuccessful
Complications of PTC include bleeding, infection (cholangitis), pancreatitis, and perforation

Indications: acute or chronic cholecystitis, recurrent biliary colic, gallstone-induced pancreatitis, biliary peritonitis due to perforation of the gallbladder or previous CBD obstruction
Usually performed laparoscopically
Conversion to open procedure is rare and should occur in exceptional circumstances