11 Acalculus cholecystitis. No other causesRecurrent biliary colic without radiographic evidence of gallstonesHistory of biliary type painNormal ultrasound
12 Complication of serious medical / surgical illness. Risk factors- Male- Trauma- Burns- Diabetes- Sepsis- CABG- TransplantPathophysiology- Visceral hypo perfusion- Bile stasis- Small vessel occlusion- visceral hyperalgesia- altered epithelial permeability
13 Rome III criteria. Functional gall bladder disorders Epigastric and or RUQ pain withEpisodes > 30 mins and progressiveSymptoms at different timesImpairs ADLs or needs ED admissionNo relief with defecation / antacids / postural changesExclusion of other structural problems+ / - nausea, vomiting, radiation to back
14 Investigations? As for suspected gallstone disease Cholecystokinin cholecystographyTc99 labelled HIDA scanProblems??
15 Management. Influence of investigations Recommendations vary Long term outcomes of cholecystectomy
16 Mrs RF. Elective open cholecystectomy Risks V’s benefits Findings Post op period