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Cholezystitis

Cholecystitis is an inflammation of the gallbladder. It most commonly refers to acute calculous cholecystitis, where obstruction of the cystic duct by gallstones leads to gallbladder inflammation, though acalculous cholecystitis can occur in critically ill patients without stones. Chronic cholecystitis results from repeated bouts of inflammation and fibrosis.

Etiology and pathophysiology: The typical sequence starts with obstruction of the cystic duct by a gallstone.

Clinical features: Acute cholecystitis presents with sudden, severe right upper quadrant or epigastric pain that may

Diagnosis: Ultrasound is the first-line test, showing gallstones, gallbladder wall thickening, pericholecystic fluid, and sometimes a

Treatment: Initial management includes hospitalization, nil per os, IV fluids, and broad-spectrum antibiotics targeting enteric organisms.

Prognosis and complications: Prompt treatment reduces risk of complications such as gallbladder gangrene, perforation, empyema, fistula

This
causes
gallbladder
distention,
stasis,
bacterial
overgrowth,
and
inflammation.
In
acalculous
cases,
gallbladder
ischemia
and
stasis
contribute.
Conditions
such
as
severe
illness,
trauma,
or
procedures
can
predispose
to
acalculous
cholecystitis.
radiate
to
the
right
shoulder
or
back,
often
lasting
several
hours.
Fever,
nausea,
and
vomiting
are
common.
A
positive
Murphy
sign
on
examination
supports
gallbladder
inflammation.
Jaundice
is
not
typical
unless
there
is
concomitant
biliary
obstruction.
sonographic
Murphy
sign.
Laboratory
studies
typically
reveal
leukocytosis;
mild
transaminase
or
alkaline
phosphatase
elevations
may
occur
if
bile
duct
involvement
is
present.
If
ultrasound
is
inconclusive,
a
HIDA
scan
can
assess
gallbladder
function
and
cystic
duct
obstruction.
CT
or
MRCP
may
be
used
to
evaluate
complications
or
other
causes.
Definitive
treatment
is
cholecystectomy,
usually
laparoscopic,
within
24–72
hours
for
acute
calculous
cholecystitis
when
feasible.
High-risk
patients
may
undergo
percutaneous
cholecystostomy
with
delayed
surgery.
formation,
or
gallstone-related
obstruction.
Chronic
cholecystitis
can
lead
to
biliary
symptoms
and
may
require
elective
cholecystectomy.