It is the inflammation of gall bladder, which may occur most commonly due to obstruction of - Cystic duct with gall stones. Females are twice as likely to develop cholecystitis.

Salient features

•           Acute pain in right hypochondrium or epigastrium. Initially pain is intermittent but later presents as constant and severe.

•           Murphy's sign is generally positive.

•           Boas sign maybe present in some cases.

•           Ultrasound is paramount in diagnosis.

Management

A.               Low fat diet. ln concurrent APD, spices are to be avoided.

B.               Definitive treatment is cholecystectomy in symptomatic and asymptomatic patients with diabetes or a solitary large stone or multiple small stones with wide cystic duct or porcelain gall bladder or anxious patients. If the patient comes after 48 hours manage conservatively and cholecystectomy after 6-8 weeks.

C.               Expectant management

In case of acute cholecystitis, empyema gall bladder.

•           Maintenance of IV fluids

•           Inj Ceftriaxone 1gm + Inj Salbactum 500mg iv twice daily

•           Inj. Ciprofioxacin (infusion 100 mg/50 ml) 100 ml IV twice a day. lnj. Gentamicin (40 mg/mI) 2 ml IV 8 hourly.

Or

•           inj. Ampiciliin (500 mg/mi) 1 ml IV 6 hourly. Inj. Cloxacillin (500 mg/ml) I ml IV 6 hourly.

Or

•           Inj. Ciprofloxacin (infusion (100 mg/50 ml) 100 ml IV twice a day. inj. Amikacin (500 mg/2 ml) 2 ml twice day.

•           In case anaerobic bacterial infection is suspected or anticipated, give Inj. Metronidazole (500 mg/100 ml) 100 ml IV 8 hourly.

•           Inj. Diclofenac sodium (25 mg/ml) 2 -3 ml IM SOS or 6 hourly. Or

•           Inj. Pentazocine lactate (30 mg/ml) 1 ml IM SOS

•           Inj. Hyoscine butylbromide (20 mg/ml) I ml IV SOS.

•           In patients having obstructive jaundice, add Inj. Vitamin K (10 mg/ml) 1 ml IM once a day for 3 days. In case of no improvement, liver functions are to be assessed. Antibiotics are usually stopped after 5-7 days unless the patient has evidence of persistent infection.

Patient education

•           To avoid fatty and fried meals for 3 months.

•           Although ambulation is encouraged as early as possible, heavy physical exertion should be avoided for 2 weeks (after laparoscopic cholecystectomy) and for 3 months after conventiorxi cholecystectomy.

•           If T-tube has been placed, it should be removed after 2-3 weeks, after ensuring that the CBD is patent and there is free flow of contrast into the duodenum during 1-tube cholangiography.