Acute Cholecytitis

Inflammation of the gallbladder most commonly caused by obstruction of the cystic duct by a gallstone

Aetiology

  • See Gallstones

Clinical presentation

Symptoms

  • Constant pain in RUQ

Signs

  • Tenderness in RUQ +/- Murphy’s sign (place hand firmly at costal margin in RUQ, sign is positive if patient has pain on inspiration)
  • Inflammatory response e.g. fever

Investigations

Imaging

  • USS
  • MRCP and/or ERCP if further clarification needed

Bloods

  • LFTs - ALP > ALT/AST, ↑ bilirubin
  • FBC and CRP - raised (inflammatory response)
  • Amylase - to check for pancreatitis

Management

  • Initial management - IV antibiotics, fluids, nil by mouth
  • Once confirmed - cholecystectomy (urgent or interval)