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The Resus Room

Podcasts from the website TheResusRoom.co.uk Promoting excellent care in and around the resus room, concentrating on critical appraisal, evidenced based medicine and international guidelines.
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Apr 15, 2017

Acute cholecystitis is a diagnosis that we make frequently in the Emergency Department. But like all diagnostic work ups there is a lot to know about which parts of the history, examination and bedside tests we can do in the ED that really help either rule in or rule out the disease.

In this podcast we run through some of the key bits of information published in the Commissioning Guide Gallstone disease 2016, jointly published by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland & the Royal College of Surgeons.

We then concentrate on a recent systematic review of the diagnostic work up for Acute Cholecystitis. Yet again the evidence base brings up some issues to challenge our traditional teaching on the topic but should help polish our management of patients with a differential of Acute Cholecystitis.

Enjoy!

References & Further Reading

Commissioning Guide Gallstone disease 2016

Up to date; Acute Cholecystitis

NICE guidance; Acute Cholecystitis

History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis. Jain A. Acad Emerg Med

1 Comments
  • four and a half years ago
    Iliya Englin
    Few surprises here - pain and tenderness should precede fever (which, anyway, is a serial measurement off antipyretics, not a single reading on arrival), let alone jaundice - aseptic obstructive jaundice is usually painless.

    I too found the Murphy sign unbeatable, even though I have owned an U/S for 11 years - BUT simple bedside imaging offers the following:

    1. You can see if the gall bladder is swollen,
    2. Presence of multiple small stones offers an additional scenario of obstruction downstream, with a higher surgical mortality,
    3. You can perform an ultrasonic Murphy's, with precise positioning.

    A presence of a calculus does not mean a lot by itself - there is no law against patients with cholelithiasis having a DU or pancreatitis (which they are more likely to have than the population). A tender gall bladder, however, is rarely an incidental finding.

    I would take a lot of persuasion not to cover with antibiotics, even if the patient stayed in hospital. G-ve septicaemia is pretty rapid in onset and has an impressive mortality.

    That is certainly not an option in a remote area.
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