See also:
Abdominal pain Ddx
Biliary disease
Pathophysiology
May be caused by undiagnosed hereditary spherocytosis
Hx
Pain that is triggered by eating fatty food
Sx
RUQ pain that may radiate under the scapula
Nausea
Vomiting
Low grade fever
Pain is usually colicky but steadily worsens until it becomes constant and unremitting
Pain may worsen with deep inspiration or jarring of the patient if the parietal peritoneum is secondarily inflamed.
Pain is not alleviated by milk or antacids (unlike in PUD)
Peritoneal signs are possible
NOT Sx
Shock and hypotension are not typical of uncomplicated cholecystitis (unless gangrene or gallbladder rupture has occurred).
Workup
CBC
AST/ALT/bilirubin/ALP
US-abdomen
HIDA scan (for cholecystitis or cholethiasis)
Workup (broader)
H. pylori antibody testing (for PUD)
Upper endoscopy (for PUD)
Rectal exam and stool for occult blood (for perforated or bleeding ulcer)
Dx
Positive murphy's sign
US is informative.
Endoscopic retrograde cholangiopancreatography (ERCP) is both diagnostic and therapeutic.
May also diagnose via MRI.
Tx
Patients with uncomplicated cholecystitis may benefit from early cholecystectomy
Patients with severe or symptomatic cholecystitis, complicated cholecystitis (an immunosuppressed patient, possible abscess, or gangrenous cholecystitis) may require emergent surgery.
