ACUTE CHOLECYSTITIS
ACUTE CHOLECYSTITIS
- Acute cholecystitis is the inflammation of gall bladder usually gallstone obstructs the cystic duct.
- Occurs in patients with pre- existing chronic cholecystitis usually.


RISK FACTORS-
- E. Coli (MC)
- Klebsiella
- S. Faecalis
CLINICAL FEATURES-
- Right upper quadrant pain with tenderness, guarding and rigidity.
- Triad- fever, leucocystitis and minimum duration 24 hours
- Murphy’s sign/ Naunyn’s sign- right upper quadrant tenderness that is exacerbated during inspiration by the examiner’s right coastal palpation.
- Boas’s sign- area of hyperesthesia between 9th and 11th ribs posteriorly on the right side (hyperesthesia at inferior angle of right scapula).

INVESTIGATIONS-
- USG- IOC (>4cm)
- Biliary radionuclide scan- no filling after 4 hours indicated obstructed cystic duct.
- HIDA/ PIPIDA scan- gold standard investigation

TREATMENT-
- Within 72 hours attack- management followed hospitalization followed by cholecystectomy.
- After 3- 6weeks elective Cholecystectomy.
Exam Important
- Acute cholecystitis is the inflammation of gall bladder usually gallstone obstructs the cystic duct.
- Occurs in patients with pre- existing chronic cholecystitis usually.
CLINICAL FEATURES-
- Right upper quadrant pain with tenderness, guarding and rigidity.
- Triad- fever, leucocystitis and minimum duration 24 hours
- Murphy’s sign/ Naunyn’s sign- right upper quadrant tenderness that is exacerbated during inspiration by the examiner’s right coastal palpation.
- Boas’s sign- area of hyperesthesia between 9th and 11th ribs posteriorly on the right side (hyperesthesia at inferior angle of right scapula).
INVESTIGATIONS-
- USG- IOC (>4cm)
- Biliary radionuclide scan- no filling after 4 hours indicated obstructed cystic duct.
- HIDA/ PIPIDA scan- gold standard investigation
TREATMENT-
- Within 72 hours attack- management followed hospitalization followed by cholecystectomy.
- After 3- 6weeks elective Cholecystectomy.
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