Characteristic Symptoms and Management of Acute Cholecystitis

Acute cholecystitis is a common acute abdominal condition that presents with a variety of distinct clinical features. Recognizing these symptoms and understanding the appropriate treatment options are essential for effective patient care.

Key Clinical Signs of Acute Cholecystitis
One of the hallmark signs of acute cholecystitis is a positive Murphy's sign. This is assessed by placing the examiner's thumb beneath the right costal margin while the patient takes a deep breath. As the gallbladder moves downward during inspiration, it may come into contact with the thumb, causing sharp pain, which is a strong indicator of gallbladder inflammation.

Common Symptoms Experienced by Patients
In addition to the specific physical finding of Murphy's sign, patients often experience a range of systemic and gastrointestinal symptoms. These include nausea, vomiting, abdominal bloating, chills, and high fever. These symptoms typically develop rapidly and may persist for several hours to days if not treated promptly.

Imaging Findings in Acute Cholecystitis
Imaging studies such as abdominal ultrasound or computed tomography (CT) scans are crucial in confirming the diagnosis. These tests may reveal an enlarged gallbladder or the presence of gallstones, which are commonly associated with the condition.

Emergency Treatment Approaches
For the initial management of acute cholecystitis, conservative, non-surgical treatment is often employed. This includes fasting and intravenous fluid administration to maintain hydration and electrolyte balance. Pain relief is typically achieved using medications such as atropine or phloroglucinol. In addition, antibiotics are a key component of therapy, with commonly prescribed options including cephalosporins and anaerobic coverage with agents like ornidazole or tinidazole.

Indications for Surgical Intervention
In cases where complications such as gallbladder perforation occur, or in patients with recurrent episodes of acute cholecystitis, surgical removal of the gallbladder (cholecystectomy) may be necessary. This intervention helps prevent further complications and provides long-term relief from recurrent inflammation.