Cholecystitis Flashcards
1
Q
Mirizzi Syndrome
A
A stone embedded in Hartmann’s pouch which is adherent to the common hepatic duct
2
Q
Complications of gallstones
A
Gallbaldder stones : acute cholecystitis, empyema, perforation, chronic cholecystitis, mucocela
Bile duct stones : acute cholangitis, obstructive jaundice, acute pancreatitis
3
Q
Chronic cholecystitis
A
- Results when the wall of gallbladder reacts to the prolonged presence of gallstones in the gallbladder.
- Results in significant dysfunction of the gallbladder
- Presents with : dyspepsia, right hypochondrial discomfort and/or pain, and fat intolerance.
- Typical patient : fat, female, forty, flatulent female.
4
Q
Biliary colic pain
A
Site : epigastric pain
Severity : Increases
Radiation: Right hypochondrium
DDX : Acute cholangitis - but BDO associated with extrahepatic ductal obstructions such as jaundice, pale stools, dark urine and pruritus. Signs : Elevation of all liver enzymes
5
Q
Empyema of the gallbladder
A
- If the stages of inflammation advances to the stage of suppuration
- Comorbid factors : Steroids, immunodeficient, other significant comorbid factors
- Imaging : Fluid around the inflamed gallbladder.
- Symptoms and signs : Irritates the parietal peritoneum and causes constant right hypocondrial pain, tenderness, guarding, rebound tenderness and some rigidity
- Complications : Necrosis, gangrene, perforation and peritonitis
6
Q
Mucocele
A
- Recent episode of biliary colic who presents with a palpable lump in the right hypochondrium
- US : distended gallbladder - no evidence of extrahepatic ductal obstruction
- Pathogenesis : Obstruction to the cystic duct when the gallbladder is relatively empty of bile. Mucous glands secrete abnormal quantities of mucus.
7
Q
Management
A
- Nil by mouth
- IV fluids and IV abx - Broad spectrum abx such as 2nd gen cephalosporin (cefuroxime)
- DVT prophylaxis
- A pre-op assessment
- Lap chole 6-8 weeks later to resolve inflammatory adhesions
