Approach of acute Cholecystitis including Hx, Examination, DDx, Ix and Treatment

1. Acute cholecystitis
The acute inflammation of the gallbladder, which is typically due to cystic duct obstruction by
a gallstone
1- Cholelithiasis
• Presence of Gallstones in the Gallbladder
2- Cholecystitis
• Inflammation of the gallbladder
3- Cholangitis
• Inflammation of the bile duct system
Etiology
1- Acute calculous cholecystitis (90%)
• obstructing cholelithiasis
2- Acalculous cholecystitis (10%)
1- Right upper quadrant pain
• Severe and prolonged (> 6h)
• Increase after meals
• Radiation to the right scapula (due to referred pain from phrenic nerve irritation)
2- Positive Murphy sign (falsely negative in patients > 60 years)
3- Guarding
4- Fever
5- Anorexia
Clinical features
Diagnostics
1- Hx. & Clinical features
2- Lab. Tests
• CBC (leukocytosis)
• CRP ↑
• LFTs
AST ↑& ALT ↑ are possible in acute cholecystitis
Signs of cholestasis Bilirubin ↑& ALP ↑& GGT ↑are uncommon in cholecystitis
3- Imaging
• U/S RUQ (Gallbladder wall thickening > 3–5 mm)
• HIDA Scan
• MRI With and Without IV Contrast
• CT-Scan With IV Contrast
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2. Treatment
1- Empiric antibiotic therapy
2- Cholecystectomy (Laparoscopic cholecystectomy)
3- Gallbladder drainage procedures
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