Gallbladder disease

March 2018 | by EMauthor


In the textbooks the pain one gets with biliary colic and cholecystitis is different, the former colicky and the latter sharp. In practice the patients description of the pain can be somewhere between the 2 fro both conditions. Management is different between the 2 conditions. Gallstones are common  -1:8 men and 1:4 women will get them. Prevalence increases with age. 80% of stones remain asymptomatic


Distinguishing Between The 2 Conditions


•Symptoms and signs go some way (in a typical presentation)

•Fever, raised WCC more suggestive of cholecystitis


Biliary Colic


•Spasmodic Central epigastric pain, sometimes felt on the right

•No fever, may have tachycardia if pain is bad

•Tender over gallbladder if it is distended


Cholecystitis


•Constant sharp/stabbing pain in right upper quadrant

•may radiate to Rt shoulder/back

•Fever, tachycardia

•Tenderness in right upper quadrant

•Murphy's sign - guarding in right upper quadrant on deep inspiration


Investigations


Do not order abdominal films in conditions such as biliary colic. Remember that a chest radiograph is equivalent to 4 days of background radiation but an abdominal film is equivalent to 4 months of radiation see here.


•USS - keep on clear fluids only when admitted until this is done

•Wall thickening / pericholecystic fluid suggest cholecystitis

•CT - not as helpful as USS


Links

•HOSPITAL ADMISSION

•HOME

•INTRANET HUB







Created with the Personal Edition of HelpNDoc: Generate EPub eBooks with ease