Acute Chelecystitis Flashcards
Definition of AC
Inflammation of-the gallbladder due to the obstruction of thecystic duet by gallstones
Affects women more
Causes or etiology
Gall stones obstructing the neck of the gallbladder
Bacterial inflammation
Sepsis
Severe trauma
Multisystem organ failure
Severe burns { reduce blood flow to gallbladder
Gallbladder tumor
Infections
Classification of A. C
Acute calculus
Acute acalculus stoneless
Acute catarrh
Phlegmonous
Gangrenous
Classification and what they entail
A. Calculus - gallstones present cystic duct is blocked normallypresent in
Obese women diabetes family with history of dislipidemia
A. A calculus_ no gallstones occurs post operative stage after major non biliary surgery / sepsis severe trauma multsystem organ failure
A. Catarrh- inflammation at the mucous membrane and submucosal membrane,there’s intense constant pain in theright hypochondrium
Epigastric regionradiatesto the right scapula shoulder and ight half of neck
Phlegmous- ‘ more intense pain aggravated by. cough and change in position of body. Repeated vomiting febrile fever purple t inflammation with infiltration of all layers of the gall bladder
Gangrenous _decrease in pain due to death ofsensitive nerve endings in thegallbladder
Partial or total necrosis of gallbladder
Symptoms ofacute cholecystits
I pain syndrome _ great acute pain in the right hypochondrium and epigastric region pain radiates to the scapula shoulder and right half of neck
- Dyspeptic syndrome-nausea vomiting may include bile,anorexia(weight loss disorder) delay of emptying gas and stool
- Ortner symptom-feel tenderness at the right costal arch by edge of palm
- Murphy symptom-involuntary breath holding on inhalation during palpation of gallbladder (when press ping right hypochondrium. Pain during inhalation
- Mussy’s symptom- soreness at palpation located between the projection on the skin of legs of the right sternum mastoid muscle
6.kehr’s symptom- increased pain at pressure on area of gallbladder
- Phrenics symptom - tenderness at pressing between the crust m sternocleidomastoideus
8.tenderness at the right quadrant
- Tongue is moist and coated
- Tachycardia fever jaundice
- In phlegmous and gangrenous tender palpable infiltrate and muscular tension may be detected
No jaundice
Method of diagnosis
. Lab _
blood count increase WCC.
Leukocytosis shif to theleft
Amylase e lipase
CRP
LFT
Ultrasound reveal gall bladder size presence of concrement
Thickness and structure of wall
Presence of liquor
Ctscan
Cholanglography
Cholecystogram
Endoscopic retrograde cholangiopancreaticgraphy _revealsconcrement in biliary duct
Laparoscopy reveals presence and form of acuteinflammation of gallbladder
Complication of acute cholecystitis and there diagnosis
l. Cholangitis~ inflammation of the bile duct caused by bacteria characterised by jaundice. Chills hectic. fever pronounced leukocytosis hyperbiliburenemia
{ CT scan } treatment (endoscopic or per cutaneous biliary drainage and decompression or choledochotomy
- Peritonitis - diffuseperforative p. Ischaracterized by abdominal wall muscle tension all symptoms of p. l2symptoms { laparoscopy }
- Abscess of. Abdominal cavity{ CT and US }
4 cholendilithasis - intensive pain due to biliary. hypertension mechanical jaundice icteric skin and sclera { us reveal enlargement of gall B.
- Fistula
Cholecysto-duodenal fistula occurs due-to bedsore ulcer of gall B wall and duodenum caused by large stools
,
Surgical treatment
Cholecystectomy open
Laparoscopic cholecystectomy
Risk factors contributory to stone formation
. Obesity diabetes melitus dietcirrhosisgastric surgery hemolytic anemia
Inflammatory bowel disease
