Discussion: Cholecystitis is inflammation of the gall bladder that occurs most commonly because of an obstruction of the cystic duct

due to cholelithiasis. Gall stones are 2-3 times more frequent in females resulting in a higher incidence of calculous cholecystitis in females. Incidence increases with age, the peak age being 40-60yrs. Patient presents with right upper quadrant pain radiating to the scapula with nausea ,vomiting and fever.The ultrasonographic diagnostic criteria can be classified into major and minor criteria. Two major or one major and two minor criteria need to be present to acheive a diagnosis. The major criteria include Gall bladder wall thickening more than 3mm, striated gall bladder wall, sonographic murphys sign positive, mucosal sloughing, pericholecystic fluid, intramural gas. Minor criteria include sludge within the gall bladder and gall bladder dilatation more than 5cm in transverse diameter. : Risk factors for calculous cholecystitis Gallstones are more common in women. Increasing age Obesity or rapid weight loss Native Americans are more prone. White people have a higher prevalence than black people. Scandinavians have a high prevalence of gallstones. Pregnancy Drugs

Risk factors for cholecystitis mirror those for cholelithiasis and include increasing age, female sex, certain ethnic groups, obesity or rapid weight loss, drugs, and pregnancy. Although bile cultures are positive for bacteria in 50-75% of cases, bacterial proliferation may be a result of cholecystitis and not the precipitating factor.

Risk: Factors that correspond to those for gallstone formation, including hyperlipidemia, high-carbohydrate diet (high glycemic load), obesity,diabetes mellitus, hemoglobinopathies and chronic alcohol use. The risk for developing cholecystitis increases with age (Gladden). Twice as many women as men are affected by this condition, and pregnancy or hormone use are observed risk factors. Certain populations including Native Americans and Hispanics are at greater risk (Gladden). Among individuals undergoing weight-loss surgery (bariatric surgery), 20% to 35% develop gallstones postoperatively (Caddy). Physical exam: The individual may have a mild-to-moderate feverindicative of infection. Pressing on (palpating) the abdomen in the area of the gallbladder and liver may reveal local tenderness. While palpating this area, the physician may ask the individual to take a deep breath. If inhalation stops when the area is pressed, this is known as a positive Murphy's sign and is characteristic of acute cholecystitis. An enlarged gallbladder palpated in some cases. Some individuals may havejaundice, a yellowish discoloration of the skin and whites of the eyes (sclerae). Some patients, especially the elderly and diabetics, may have atypical findings.

Symptoms Cholecystitis is often accompanied by presence of gallstones. The classical patient with cholecystitis is described as "fat, forty, female and fertile". The main symptom is abdominal painin the right upper part of the abdomen (right hypochondrium). Fever (from infection), nausea and vomiting may also occur. The main clinical sign is tenderness in the right hypochondrium