Cholecystitis
Physical
Exam
History
Pain
OLD CARTS
Medical History
Cardiac Fxn
Pulmonary Fxn
Surgical History
Medications
Anticoagulation
Beta Blockers
Chronic Opioids
Chronic steroid use
Allergies
Physical Exam
Heart
Lungs
Abdomen
RUQ Tenderness
Murphy's Sign
Surgical Scars
Labs
CBC
Leukocytosis
CMP
Electrolytes
Liver function
hyperbilirubinemia?
Amylase/Lipase
R/O other pathology
Lactic acid
R/O sepsis
resuscitation adequacy
Urine pregnancy
Female of childbearing age
Imaging
CT scan
Ultrasound
GB wall thickening
Pericholecystic fluid
Stones/Sludge
CBD Diameter
Sonographic Murphy's sign (U/S Only)
HIDA
radionucleotide scan
Gold Standard
Ejection fraction
absence of gallbladder filling @ 60 minutes
used when other findings equivocal
Treatment
Surgery
Antibiotics!
Gram negatives
anaerobes
Open cholecystectomy
Right subcostal incision
longer recovery time
increased post-op pain
Laparoscopic Cholecystectomy
Small incisions
shorter recovery
decrease post-op pain
Cholecystostomy tube
critically ill
mechanically ventilated
need for blood pressure support
norepinephrine
vasopressin
epinephrine
cannot tolerate anesthesia
pulmonary reserve
cardiac function
Symptoms
Asymptomatic
Nausea
Vomiting
Bloating
Pain
Post-prandial
Right upper quadrant
colicky
constant
Right shoulder/back
Jaundice
icterus
skin yellowing
Fever
subjective
chills
diaphoresis
objective
temp >38.5C
Differential
Diagnosis
Biliary colic
symptomatic
asymptomatic
Biliary dyskinesia
Gallbladder ejection fraction
See HIDA scan
cholecystitis
choledocholithiasis
cholangitis
gallstone pancreatitis
gallstone ileus