Cholecystitis

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Cholecystitis

History

Acutely

• persistent RUQ pain
  • radiates to back
• vomiting

Examination

• Localised RUQ pain
• peritonitis

Investigations

• Bloods
  • FBC, U&E, LFTs, amylase
• AXR
• CXR
• USS
  • thick-walled gallbladder + stones
• HIDA scan
  • non-filling

Treatment

• fluids
• antibiotics
  • cephotaxime 1g QDS + metronidazole 500mg TDS
• analgesia
• anti-emetics
• If settles within 24 hours then elective cholescystectomy at 6 weeks
• if progression then emergency cholecystectomy
• heparin / clexane
• TEDS
• urinary catheter

Complications

• biliary colic
• gangrenous / perforated gallbladder
• empyema
• ascending cholangitis
• obstructive jaundice
• carcinoma
• gallstone ileus
• acute pancreatitis

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