Acute cholecystitis

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It is an acute inflammation of the gallbladder.  Infection may be mild to moderate.  The condition usually resolves with conservative management, but may lead to gangrene, perforation or abscess formation.

Symptoms

Unremitting & presenting with more severe pain than biliary colic.  Pain in right upper quadrant or epigastrium associated with anorexia, nausea, vomiting, or chills.

Signs

  • Fever is usually present.
  • A tender mass is usually palpable in the right hypochondrium.
  • Mild jaundice may be present.  Moderate to severe jaundice suggests presence of inflammation or obstruction of common bile duct.

Investigations:

  • TLC is markedly raised.  (12000 to 15000 cmm/L).  A TLC more than 20,000 suggests gangrene, perforation, or cholangitis.
  • LFTs are usually slightly raised.
  • Ultrasonography confirms the diagnosis.

Management

  • Hospital admission.
  • Nothing orally till nausea and vomiting settles.
  • I/V fluids.
  • I/V antibiotics (2nd 0r 3rd generation cephalosporins).

Analgesic

Inj. Diclofenac sodium 75 mg deep intragluteal  BD for  48 hours

Inj. Nalbufin 0.3mg/kg I/V x  6 hourly

Tab. Paracetamol 2 x TDS

Tab. Naproxen sodium 2 x TDS

Cap. Campax 50mg  1 x BD

Conservative management is reassessed frequently. If the patient is improving clinically, she may undergo early cholecystectomy on next available elective list if patient does not improve or deteriorates then consider:

1-   Change of antibiotic or

2-   Emergency cholecystectomy.