Acute and Chronic

Cholecystitis
Presented by Roll No 71

Acute Cholecystitis - Definition

It is an acute inflammation of the gall bladder.
It may be due to the presence of stones or due to
bacterial infection.

Types
Calculous: Also called as obstructive cholecystitis
Causative organisms: E. coli, Salmonella, Klebsiella
Acalculous: Non-obstructive cholecystitis
Acute emphysematous cholecystitis

Pathogenesis
In acute calculous cholecystitis:
Stone
Obstruction/Mucosal Erosion
Bacterial Proliferation
Necrosis and perforation

Clinical features
Pain in right upper quadrant
Colicky
Nausea and vomiting
Fever
Pain radiating to right shoulder

Signs
Murphys sign

Boas sign
Upper abdominal guarding/rigidity

Investigations
Blood: Increased WBC count
Liver function tests
Alkaline Phosphatase, bilirubin
Lipase/amylase to exclude pancreatitis

X-ray
Gall stones

Ultrasonography
Posterior acoustic shadow

HIDA Scan

Treatment
Conservative:
1. Admission
2. Analgesics + Antispasmodics 8-10 mg morphine
IM + 0.6 mg atropine
3. Antibiotics: Cefazolin, amikacin
4. IV fluids, no oral feeding
Cholecystectomy: Early/Emergency/Prophylactic

Chronic Cholecystitis
It occurs as a result of repeated attacks of cholecystitis
Gall bladder is fibrosed, shrunken, contracted.
Gall bladder wall is thickened.
Multiple gall stones present

Symptoms and Signs

Same as for acute attack of cholecystitis
Also fatty food intolerance
Same investigations as for acute cases: reveals shrunken
and contracted gall bladder on USG with gall stones
Treatment: Cholecystectomy