acute cholecystitis Flashcards
definition
inflam of the gallbladder caused by stone lodged in cystic duct
risk factors
women, obese, increased age, highest in mex/americans, hypertriglyceridemia may promote gallstones
cause
gets signal to secrete bile to help w/ digestion, gallbladder contracts and stone gets stuck, as the stuck increases bile becomes an irritant, mucosa secretes mucus and enzymes, bacterial growth starts
S&S
pain starts in epigastric then RUQ radiates to shoulder, dull achy pain peritonitis fever leukocytosis vomit rebound tenderness/guarding jaundice \+ murphys sign
where does pain start and then radiate to
starts in the epigastric area, then RUQ radiates to the shoulder
quality of pain
dull achy
diagnosis
US confirms, HIDA, ercp, mrcp, ct
US confirms by seeing what
sludge, bile duct distention, gallbladder wall thickening
diff
perforated peptic ulcer, acute pancreatitis, appy, perforated diverticulum, liver abscess, hepatitis, pna, myocardial ischemia
complications
gangrene and chronic cholecystitis
when does gangrene happen
24-48 hrs suggest severe inflammation and poss gangrene which can lead to perforation and abscess
treatment
Admit: npo, ivf, anagesic
iv abx: 2nd/3rd gen: cephalosporin: + flagyl
admit
monitor for gangrene, US guided aspiration delay sx, cholecystectomy within 24 hrs of admit