Acute inflammation of the gallbladder, usually from cystic-duct obstruction by a gallstone.
Clinical features
- • RUQ pain >6 h
- • Fever
- • Nausea, vomiting
Examination
- • Murphy's sign positive
- • RUQ tenderness, guarding
- • Palpable gallbladder (uncommon)
Investigations
- • FBC, LFT, lipase, CRP
- • USS: wall >3 mm, pericholecystic fluid, stones
- • HIDA if equivocal
- • MRCP if CBD stone suspected
Diagnosis
- • Tokyo Guidelines TG18 criteria
Differential diagnosis
- • Biliary colic
- • Ascending cholangitis
- • Hepatitis
- • Peptic ulcer
- • Right lower lobe pneumonia
Management
- • NBM, IV fluids, analgesia, antibiotics
- • Early laparoscopic cholecystectomy <1 week ideal
- • Percutaneous cholecystostomy if unfit
Drug therapy
- • Co-amoxiclav 1.2 g IV q8h
- • Add metronidazole if severe
Complications
- • Empyema, gangrene, perforation
- • Gallstone ileus
- • Mirizzi syndrome
Clinical pearls
- • Always image CBD before lap chole if jaundice / dilated CBD
Related in WardRound
Educational — verify locally.
