Inflammation of the gall bladder

Caused by:

• blockage of the cystic duct (prevents drainage)
• key complication of gall stones (95% of cases) - trapped at neck of gall bladder or cystic duct
• acalculous cholecystitis - small number of cases can be caused by something other then gallstones - may occur in parental nutrition (IV nutrition) or long periods of fasting (e.g. ICU) where the gallbladder is not being stimulated by food to regularly empty, resulting in a build-up of pressure.

Differentiating between acute and chronic cholecystitis - Both usually involve inflammation, acute is accompanied by an infection due to trapped bacteria by the sudden blockage (blood tests).

Risk factors -

• the 5 F's of gallstones - fat, female, forty, fertile, fair
• Hispanic

PC:

Main symptom - Pain in the RUQ - may radiate to shoulder, patients have between 1 and 4/5 days of pain. patient may say they've had this before but it went away, they may have had biliary colic or chronic cholecystitis before in this instance it may also be infected which is why they've come in.

Other Sx:

• Fever
• Nausea and Vomiting
• Tachycardia and tachypnoea
• Myalgia
• Jaundice - likely to occur if a stone blocks the CBD, in which case the bile will back up into the liver and then into the blood. NOTE: this is not a strict sign of acute cholecystitis, it indicates something else is occurring as well as this, e.g. choledocolithiasis.

Note - stones blocking the gallbladder neck or cystic duct will not cause jaundice