Definition: Acute inflammation of the gallbladder, typically due to obstruction of the cystic duct. Etiology: Gallstones: Responsible for 90% of cases. Acute acalculous cholecystitis: In 10% of cases, no cause of obstruction is found. Notably seen at extremes of age and associated with trauma, burns, and surgery. Pathophysiology: Obstruction causes chemical irritation due to bile stasis. Subsequent onset of bacterial infection. Clinical Presentation: Right upper quadrant pain: Can radiate to the back and shoulder tip. Associated with vomiting. Systemic symptoms: Such as fever and raised inflammatory markers. Murphy’s sign: Pain during palpation below the right costal margin on inspiration, although present in only 40% of cases. Diagnostic Evaluation: Ultrasound: Gold standard, shows gallbladder wall thickening, pericholecystic fluid, and stones if present. Blood tests: Elevated white blood cell count, CRP, and potentially liver function tests. Management: Conservative measures: IV fluids IV antibiotics (commonly broad-spectrum like co-amoxiclav) Analgesia If symptoms persist or complications develop: Urgent intervention, e.g., drainage for gallbladder empyema. Cholecystectomy: Usually performed electively ~6 weeks after symptom resolution, but may be emergent if conservative measures fail. Complications: Gallbladder empyema (pus-filled). Gallbladder gangrene or perforation. Biliary peritonitis. Cholangitis.
