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%)
    

 

 

 

 

 

 

 

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