Acute Cholecystitis

Acute Cholecystitis: Pathogenesis and clinical findings
Authors: Yan Yu Reviewers: Dean Percy, Mirna Matta, Crystal Liu, Maitreyi Raman* * MD at time of publication
Dull diffuse abdominal pain, may be felt more in RUQ, may radiate to the back and right shoulder
Fever, Nausea/Vomitting, tachycardic
• Persistent RUQ pain, abdominal guarding and peritoneal signs
• Positive Murphy’s sign Dehydration
Gallstone blocks cystic duct, backing up bile into the gall bladder
Gallstones causing physical trauma to gallbladder wall
Irritation of gall bladder wall
↑ Gall bladder lumen pressure, ↓ blood flow to gall bladder
Ischemia, gall bladder necrosis, inflammation, loss of gall bladder structural integrity
Bacterial invasionàtransmural inflammation of gall bladder
Over time, continued inflammation of the gall bladder can cause complications
Irritates visceral peritoneum, stimulates foregut autonomic nerves (T5-T8)
Inflammation self-perpetuates
Triggers cytokine release
Irritation of parietal peritoneum, stimulates somatic nerves
Inflamed vessels are more permeable and leak fluid from the blood into the colon
Gall bladder Gangrene (20%)
Gall bladder perforation (20%)
Note: Further Investigations could include:
• CBC: leukocytosis (due to inflammatory response) • Ultrasound: Gold Standard Diagnostic test; shows
inflamed/thickened gall bladder wall, and presence of gallstones
Note: To properly check for Murphy’s sign: palpate RUQ with patient breathing in. Inspiration expands lungs and pushes inflamed gall bladder down below rib cage, meeting examiner’s hand, causing pain and premature termination of inspiration.
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published August 4, 2019 on www.thecalgaryguide.com