Patient handout

Acute Cholecystitis

PRODUCTION

1. Your condition

This handout is for acute cholecystitis. Your care team identified this based on: right upper quadrant pain (acg 2024).

Other reasons your team may use this plan: positive murphy sign on exam (acg 2024); fever / nausea after fatty meal (acg 2024); us showing gb wall thickening, pericholecystic fluid (acg 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cefazolin	1-2 g IV q8h	IV	q8h	TG18 — narrow-spectrum gram-positive + most enteric gram-negatives; appropriate for grade I CAI (ACG 2024)
ceftriaxone	2 g IV daily	IV	daily	Broader gram-negative coverage when biliary stasis suspected (ACG 2024)

Plan: Acute cholecystitis — TG18 grade-driven antibiotics + early lap cholecystectomy (ACDC) (ACG 2024)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

TG18 grade III — organ dysfunction (CV, neuro, resp, renal, hepatic, hematologic) (ACG 2024)(life-threatening)
CT shows gangrene, gas in GB wall (emphysematous), or wall hemorrhage (ACG 2024)(life-threatening)
Free intraperitoneal fluid + air, peritoneal signs (ACG 2024)(life-threatening)
Bilirubin >4 + CBD dilation + Charcot triad — cholangitis overlap (ACG 2024)
TG18 II-III in surgical-prohibitive patient (severe comorbidity, ASA IV-V) (ACG 2024)
ICU/TPN/major surgery patient with new RUQ inflammation, gallbladder distension without stones (ACG 2024)

5. Follow-up

Post-op clinic 2-4 weeks + path review; interval chole 4-6 weeks after PTGBD; LFT normalization for CBD stones (ACG 2024)

6. Sources

Guideline: Tokyo Guidelines 2018 (TG18) + WSES 2020 Acute Calculous Cholecystitis + SAGES Safe Cholecystectomy 2020 + ACDC Trial (Ann Surg 2013) + CHOCOLATE Trial (BMJ 2018)