Cholecystitis

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Acute cholecystitis is a condition which is becoming more frequent in our population as major lifestyle changes occur with dietary shifts towards a western diet. This has increased the incidence of cholesterol related illness of which gallstone disease is one.

Calculous cholecystitis (gallstone-related cholecystitis) is the commonest indication for cholecystectomy in Zimbabwe. In young patients' exclusion of haemolytic anaemia especially sickle cell anaemia is important.

While the definitive treatment for cholecystitis is surgery i.e. open cholecystectomy or laparoscopic cholecystectomy it is necessary to give antibiotics for acute cholecystitis. While acute cholecystitis typically presents in a forty-year-old, fat, fertile, flatulent and fair female it can also occur in males, in both younger or older age groups. The symptoms are mainly acute right upper quadrant pain usually at night after a fatty meal with some milder previous episodes of colicky upper abdominal pains. On examination tender right upper quadrant is typical with a positive Murphy sign (catch of breath on inspiration while the palpating hand is advancing up from the right iliac fossa to the right costal margin).

Treatment of acute cholecystitis

Antibiotics and analgesia are important.

First Line:

	Medicine	Dose	Frequency	Duration
	ampicillin iv	500mg	4 times a day
and	metronidazole iv	500mg	3 times a day
Alternative to Ampicillin (if not available):
and	benzyl penicillin iv	2.5mg	4 times a day

Second Line

	Medicine	Adult Dose	Frequency	Duration
	ceftriaxone iv	1g	2 times a day
and	metronidazole iv	500mg	3 times a day

Patients are managed as above and if symptoms and signs improve can be discharged on oral, amoxicillin 500mg tds for 7 days and scheduled for elective cholecystectomy after six weeks.

Advances in laparoscopic surgery have however made it possible to do early or "hot" cholecystectomy when certain criteria are met based on expertise of the surgeon.