Cholecystitis Flashcards
what is Cholecystitis
inflammation of the gallbladder that may take one of several forms
what are types of Cholecystitis
Acute, chronic
acalculous
emphysematous
gangrenous
indications of cholecystitis
Thickened gallbladder wall >3 mm •Distended gallbladder lumen >4 cm •Gallstones •Impacted stone in Hartmann’s pouch or cystic duct •Positive Murphy’s sign •Increased color Doppler flow •Pericholecystic fluid collection
Acute cholecystitis
Most common cause of acute cholecystitis is gallstones.
Acute cholecystitis is caused by stones being impacted in the cystic duct or in the neck of the gallbladder (Hartmann’s pouch).
Clinical signs of acute cholecystitis
Acute right upper quadrant pain
Positive Murphy’s sign
Inspiratory arrest upon palpation of gallbladder area
Fever
Leukocytosis
Increased serum bilirubin and alkaline phosphatase levels
Complications of acute cholecystitis
May be serious and include empyema, emphysematous or gangrenous cholecystitis, and perforation
treatments for cholecysitis
Antibiotics
Surgery Cholecystectomy
Laparoscopic or open cholecystectomy
Complications
what should other fluid collections be monitored for
signs of change or peristalsis.
where is significant fluid collected
The significant fluid is collected in the antrum and the duodenum changes shape; distinct peristaltic movement is observed with real-time imaging.
what is emphysematous cholecystitis
Rare complication of acute cholecystitis
Rapidly progressive and fatal in 15% of patients
who is affected more often by emphysematous cholecystitis
Affects more men than women; 50% of patients are diabetic; gallstones may not be present in 30% to 50% of patients
what is emphysematous cholecystitis associated with
Associated with the presence of gas-forming bacteria in the gallbladder wall and lumen with extension into the biliary ducts
a complication of emphysematous cholecystitis
Gangrene with associated perforation is a complication.
what is emphysematous cholecystitis considered to be
This condition is a surgical emergency.
what will sonographic appearance depend on in emphysematous cholecystitis
Sonographic appearance depends on the amount of gas within the wall of the gallbladder.
if the gas is intraluminal (emphysematous cholecystitis)
Prominent bright echo is demonstrated along the anterior wall with a ring down or comet-tail artifact directly posterior to the echogenic structure.
if a large amount of gas is present (emphysematous cholecystitis)
Appears as a “packed bag” or WES sign with a curvilinear echogenic area with complete posterior fuzzy shadowing
what is gangrenous cholecystitis
Is a serious, painful complication of acute cholecystitis that may lead to perforation.
Occurs after a prolonged infection, which causes the gallbladder to undergo necrosis.
what may the appearance of the gallbladder be (gangrenous cholecystitis)
Gallbladder wall may be thickened and edematous with focal areas of exudate, hemorrhage, and necrosis.
Ulcerations and perforations may be present, resulting in pericholecystic abscesses or peritonitis.
Gallstones or fine gravel occur in 80% to 95% of patients.
what is the common echo feature of gangrenous cholecystitis
The common echo feature of gangrene is the presence of diffuse medium to coarse echogenic densities filling the gallbladder lumen in the absence of bile duct obstruction.
what does the echogenic material of gangrenous cholecystitis have
Does not cause shadowing
Is not gravity-dependent
Does not show a layering effect
what is acalculous cholecystitis
Is the acute inflammation of the gallbladder in the absence of cholelithiasis
Is most likely caused by decreased blood flow through the cystic artery
what may precede the development of acalculous cholecystitis
Conditions that produce depressed motility (e.g., trauma, burns, postoperative patients, HIV, etc.) may precede the development of acalculous cholecystitis.
what else may cause acalculous cholecystitis
Extrinsic compression of the cystic duct by a mass or lymphadenopathy may also cause this condition.
Clinical finding of acalculous cholecystitis
Clinically, the patient has a positive Murphy’s sign.
