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Cholecystitis (Risk factors (Estrogen replacement therapy, Diabetes…
Cholecystitis
Risk factors
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Drugs: Octreotide, Clofibrate, Ceftriaxone
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Likely presentation
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Tachycardia, pyrexia, nausea, vomiting, leucocytosis (Increased WCC)
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Investigations
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RUQ USS
Recommended for every person with suspected acute cholecystitis because of its accuracy for detecting gallbladder stones and its availability, cost, and lack of invasiveness
Abdominal CT scan
can show gallbladder distension, wall thickening, and complications such as abscess and perforation. It can be useful if ultrasound findings are limited by gaseous distension or obesity
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Epidemiology
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Three times more likely in women than in men up to age 50. 1.5 times more likely in women than in men thereafter
Acalculous cholecystitis accounts for 5-14% of acute cholecystitis cases. Incidence is high in ICU, especially in burns and trauma units
Pathophysiology
Gallstones cause obstruction in the cystic duct or gallbladder neck causing inflammation of the gallbladder wall
Trauma caused by the gallstone stimulates prostaglandin synthesis (PGI2, PGE2), which mediates the inflammatory response. This can result in secondary bacterial infection leading to necrosis and gallbladder perforation
Untreated acute cholecystitis can lead to suppurative, gangrenous, and emphysematous cholecystitis.
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BMJ BEST PRACTICE. 2018. Cholecystitis [online]. BMJ Best Practice. [viewed on 1 April 2019]. Available from: //bestpractice.bmj.com/topics/en-gb/78
Neoptolemols, PJ., Bhutani, MS., 2008. Fast facts: diseases of the pancreas and biliary tract. Oxford. Health Press
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