In this episode, we break down chronic cholecystitis using a practical, clinically focused framework. We review the pathophysiology of recurrent gallstone obstruction leading to chronic inflammation and fibrosis, along with hallmark history and exam findings such as postprandial right upper quadrant pain with typically normal labs. The discussion highlights first-line imaging, including ultrasound and HIDA scan interpretation, and clarifies how to distinguish chronic disease from acute cholecystitis and biliary colic. We conclude with evidence-based management, patient counseling, and clear indications for elective laparoscopic cholecystectomy.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Gallaher JR, Charles A. Acute Cholecystitis: A Review. JAMA. 2022;327(10):965-975. doi:https://doi.org/10.1001/jama.2022.2350

3) Strasberg SM. Acute Calculous Cholecystitis. New England Journal of Medicine. 2008;358(26):2804-2811. doi:https://doi.org/10.1056/nejmcp0800929