Surg: Acute Cholecystitis: Free MSRA Podcast

🔥 FREE MSRA PODCAST – Acute Cholecystitis: Gallstones,Murphy’s Sign & Urgent Management 🎧A sharp RUQ painbrings them to A&E. And your exam question? It's classic acutecholecystitis. This is your no-fluff, high-yieldaudio revision guide covering causes, diagnosis, and treatment – straight fromour MSRA notes. Let’s make it stick. 🧠Key Learning Points📌Definition• Inflammation ofthe gallbladder, usually caused bygallstone obstruction of the cystic duct• Can lead to infection, necrosis,and perforation if untreated• 90–95% are calculous (gallstones); 5–10% are acalculous (critically unwell patients) 📌Causes &Gallstone Types• Cholesterol stones – 80%, radiolucent, oftensingle• Black pigment stones – haemolysis, cirrhosis• Brown pigment stones – infection, biliarystasis• Mixed stones – combination of pigment andcholesterol• Non-gallstonecauses: sludge, ischaemia, tumour🧠Mnemonic – 4 Fs ofGallstone Risk:Female, Forty, Fat, Fertile 📌Risk Factors• Gallstones or biliarysludge• Rapid weight loss,pregnancy, oestrogen (COCP, HRT)• Crohn’s disease,hyperlipidaemia• Older age, femalesex, family history 📌PathophysiologyGallstone blocks cystic ductBile backs up → pressure → inflammationGallbladder wall becomes ischaemic → necrosis/perforation possibleBacterial overgrowth may occur (often E. coli) 📌Symptoms & Signs🩺Constant RUQ pain (may radiate to right shoulder or back)🩺 Nausea, vomiting, fever,systemic unwellness🩺Murphy’s sign positive: pain stops inhalation on RUQ palpation🩺 Guarding, rebound tenderness🩺 ↑ WCC, ↑ CRP; LFTs may be mildly raised🧠Differentials:• Biliary colic (no inflammation, episodic pain)• Acute hepatitis,peptic ulcer, pancreatitis, gastroenteritis• Gynae, renal,cardiac causes in broader presentations 📌Investigations🧪 Bloods: FBC, LFTs, CRP🧪 β-hCG (in females), urine dip🖥️ Imaging:• Ultrasound (1st-line): stones, wall thickening,pericholecystic fluid• MRCP – if CBD stone suspected• HIDA scan – gallbladder non-visualisation =duct obstruction• ERCP – for therapeutic removal of CBD stones• CT scan – for complications (e.g., perforation,abscess) 📌Management🚑Initial:• IV fluids, analgesia, antibiotics(e.g. co-amoxiclav)• NPO (nil by mouth)• Supportive care🔪Definitive:• Laparoscopic cholecystectomy (within sameadmission, ideally <72 hrs)• If unfit forsurgery: Percutaneous cholecystostomy(drain insertion)⚠️CBD stone present? → Pre/post-op ERCP 📌Complications❗ Gallbladder gangrene, perforation❗Peritonitis, abscess, empyema, sepsis❗ Chronic cholecystitis or gallstone ileus❗ CBD obstruction → cholangitis,jaundice🧠Mnemonic – PPPPSPerforation, Pus (abscess), Peritonitis, Sepsis, Stonein duct 📌Prognosis✅ Excellent if managed early⚠️ Delay = ↑ risk of complications⚠️ Surgery-related bile duct injury (rare: ~0.3–0.5%)⚠️ Some may experience post-cholecystectomy GIsymptoms (usually minor) 📎More MSRA Resourcesfor Acute Cholecystitis📝 Revision Notes:https://www.passthemsra.com/topic/acute-cholecystitis-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/acute-cholecystitis-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/acute-cholecystitis-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/acute-cholecystitis-rapid-quiz/🔍 Full Quiz Access:https://www.passthemsra.com/quizzes/acute-cholecystitis/📚 Surgery Course:https://www.passthemsra.com/courses/surgery-for-the-msra/ #MSRA#AcuteCholecystitis #Gallstones #MurphysSign #MSRASurgery #MSRAFlashcards#MSRAQuiz #PassTheMSRA #FreeMSRA #RUQPain #GallbladderAttack#LaparoscopicSurgery #MRCP #ERCP #MurphySignPositive