Galbadder disease 2 _ نوري حنون Flashcards
Cholecystitis causes
Calculous 85 – 95 %
Acalculous 5 – 15 %
what’s the most common organism that cause acute Cholecystitis ?
1-E.coli . 2- klebsiella
3-streptococcus faecalis
The most common bacteria isolated from bile in acute cholecystitis are E. coli, Klebsiella, and Enterococcus faecalis, thus antibiotic therapy should be directed against these organisms.
while the others are rare
4- bacteroid .
5- clostridia & typhoid (uncommon & serious).
Causes of acute cholecystitis
1-Stone in 90% impacted in Hartmann’s pouch or obstructing cystic duct .
2- Stasis
3- Pancreatic juice reflux 4 – CBD stone .
5- Bacteremia .
6 – Vascular effect of → D.M.
→ sickle
→ hypertension
→ collagen disease
cystic artery thrombosis → ischemia .
but the most common cases are the DM or sickler
Clinical features of acute cholecystitis
1- sudden onset .
2- 30 – 70 years & > 60 years 25% - 35% .
3- White caucasian > black people .
4- Heavy fatty meal .
5- Pain (colicky).
6- Nausea & vomitting .
7- Fever > 38̊ C . low grade
8- Boas’s sign .
Boas’s sign is hyperaesthesia (increased or altered sensitivity) below the right scapula can be a symptom in acute cholecystitis (inflammation of the gallbladder). It is one of many signs a medical provider may look for during an abdominal examination.
9- Jaundice ? is rare
10- Murphy sign .
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive
11- Tenderness & rigidity .
12- Palpable tender mass .
DDx of the acute cholecystitis
1- Appendicitis . 2- Perforated peptic ulcer .
3- Acute Rt. Pyelonephritis 4- Liver abscess .
5- Rt. Lower lobar pneumonia. 6- Hepatitis
7- Pancreatitis 8- Herbes zoster .
9- *Myocardial infarction
but the main are pancreatitis. peptic ulcer disease.and MI
The sequelae of attack of the acute cholecystitis
1- Resolution ; disimpaction of the stone & drainage , slipping back of the stone.
2- Impacted stone persist → gangrene , mucocele , empyema .
3- Perforation .
4- Chronic .
Dx of the acute cholecystitis
1- ultrasound thick wall , dilateted with fluid
2- Radio isotop scan ( HIDA ) .
3- L.F.T.
4- WBC ___ leucocytosis .
Treatment of the acute cholecystitis ?
A- Conservative Rx followed by laparoscopic Cholecystectomy (after 6-8 weeks).
B- immeddate Laparoscopic Cholecystectomy .
conservative treatment of the acute cholecystitis ?
90% of cases the symptoms subside.
1- N.G. tube & *nil per mouth .
2- Antibiotics e.g.; cefazolin , Cefotaxim , gentamicin .
3- Analgesia & antispasmatic .
Cholecystoctomy done
→ Early 2 – 3 – 5 days .
→ Delayed ˃ 6 weeks
depend on the the pt status
when we do open surgery ?
rarely Open
-if laparoscopic is not accessible
-or in case of conversion
Conversion rate in acute cholecystitis more than in elective ( delayed ) but still conversion not failure of laparoscopic cholecystectomy
Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation
Chronic cholycystitis
thickened , fibrosed and shrinkage gallbladder wall
Chronic cholycystitis symptoms
1- Pain : episodes of Rt. hypochondrial pain of varying severity & interval ( 3 – 12 hours) after .
less sever
2- Flatulent dyspepsia , fullness , belching , heartburn & distension .
3- nausea & vomiting
no fever no morphy sign no WBC or LFT
Dx of Chronic cholycystitis
1- ultrasound thick wall , shrinkage without fluid
2- Radio isotop scan ( HIDA ) .
3- L.F.T.
4- WBC ___ leucocytosis .
Rx of Chronic cholycystitis
Cholecystectomy
