SHM's Clinical Quick Talks-Cholecystitis

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Cholecystitis is the inflammation of the gallbladder, usually caused by gallstones obstructing the cystic duct. In some cases, it can be caused by other factors such as edema. Gallstones are quite common in adults, with 10-20% of the population affected. Approximately 10% of patients with gallstones develop cholecystitis or biliary colic. The diagnosis of cholecystitis is based on a history of right upper quadrant or epigastric pain, accompanied by symptoms such as nausea, vomiting, and fever. Physical examination may reveal tenderness in the right upper quadrant and a positive Murphy's sign. Laboratory tests may show elevated white blood cell count and liver enzymes. Ultrasonography is the preferred imaging modality for diagnosis, looking for the presence of stones, gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy's sign. HIDA scan is used when ultrasound is inconclusive, and a non-visualization of the gallbladder suggests obstruction of the cystic duct. CT scan may be used in specific cases to look for gas in the gallbladder wall. Treatment of cholecystitis involves surgery as the definitive therapy, with cholecystectomy being the gold standard. Antibiotics may be used in cases where there is a high suspicion of infection. Timing of surgery depends on the patient's clinical condition and other factors such as the presence of sepsis or choledocholithiasis. There are also different syndromes and pathologies associated with cholecystitis, including emphysematous, acalculous, hydrops, and Mirizzi syndrome.

Asset Subtitle

Vikas Parekh

Keywords

cholecystitis

gallbladder

gallstones

cystic duct

diagnosis

ultrasonography

HIDA scan

treatment

cholecystectomy

syndromes