Cholecystitis

	Inflammation of gallbladder
Etiology	Calculous or acalculous - acalculous believed to be worse prognosis Causative organisms: E. coli, enterococci, bacteroides, staph, clostridium (emphysematous cholecystitis)
Epidemiology	Risk factors: gallstones (calculous), acalculous - TPN, narcotics, immobility, starvation.
Clinical presentation	RUQ pain, fever, previous biliary/R shoulder pain, anorexia, nausea Murphy’s sign (arrest on inspiration on inspiration with pressure on RUQ) LFTs: cholestatic pattern - ↑ ALP, GGT, bili
Pathogenesis	Calculous: impacted stone ⇒ bile accumulation ⇒ inflammation, ↑ pressure. Acalculous: bile stasis + ↑ bile concentration → CCK-induced gallbladder contraction
Diagnostic investigations	ECG: rule out myocardial infarction Amylase - rule out acute pancreatitis USS - gallstones CT abdo may show thickened gallbladder wall, fat stranding and fluid
Management	Resuscitation: treat as intra-abdominal sepsis Stable patient: - NBM, IV Abx (e.g. cefuroxime), fluids, analgesia - elective cholecystectomy - Cholecystostomy (i.e. biliary drain)

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