Symptoms & Signs
of Acute Cholecystitis
Symptoms
§ 75% have prior history of biliary colic
§ RUQ pain >90%
§ Fever 50%
Signs
§ Fever 50%: may be absent in elderly, gangrenous cholecystitis or empyema GB
§ Jaundice 20% : mild jaundice
§ RUQ tenderness
§ Murphy’s sign: S 65%, Sp 87%*
Investigations in Acute Cholecystitis
§ CBC : no leukocytosis in 1/3 of patient, esp in elderly and gangrenous cholecystitis
§ LFT : hyperbilirubinemia in 20% (TB <6 mg/dl), AP usually normal
§ Ultrasonography : sensitivity 88%, specificity 80% from meta-analysis
§ Gallstones
§ Thickening GB wall > 4 mm
§ Edema of GB (‘double wall sign’)
§ Pericholecystic fluid
§ Sonographic Murphy’s sign (PPV 90%, NPV 90%)
LC in Asymptomatic GS
Indicated
§ Porcelain GB
§ Travel to remote area
§ During await for organ Tx
§ During wt. loss surgery
§ Sickle cell anemia
§ Young Amerindian (GBCa 20x)
§ GS in children
Controversial
§ GS >3 cm (GBCa 9x)
Not indicated
§ DM
§ Thalassemia
§ Dyspepsia
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