L12: Cholecystitis Flashcards
Def of Cholecystitis
- Acute bacterial inflammation of the gall bladder with or without stone
Types of Cholecystitis
Def of Acute Cholecystitis
Majority of calculous acute cholecystitis are due to organisms such as ……
- E. coli
- Salmonella
- Streptococci
- Klebsiella, etc.
Typhoid & acute Cholecystits
Typhoid fever: can also cause Typhoid Cholecystitis around 2nd week of infection.
Clostrium & acute Cholecystitis
Clostridial infection of the gall bladder produces acute cholecystitis with toxemia.
Pathogenesis of Acute Cholecystitis
Type of Patient in Acute Cholecystitis
fatty, fertile, female
Acute Cholecystitis in a young boy?
You may be surprised to find a young boy, a girl or even a child with gall stones suspect hemolytic anemias.
CP of Acute Cholecystitis
Signs in Acute Cholecystitis
- Murphy Sign
- Boas’ Sign
- Vague Mass
- Upper abdominal guarding, rigidity
Importance of Murphy sign
Is a diagnostic sign of acute cholecystitis
Technique of Murphy sign
1) Keep the fingers in the right hypochondrium.
2) Ask the patient to take a deep inspiration.
Result of Murphy sign
+ve murphy’s sign
- At the height of inspiration there is a sudden catch in the inspiration.
Explanation of Murphy sign
It is due to inflamed gall bladder coming in contact with the abdominal wall under the fingers & producing pain.
Boas’ Sign
An area of hyperaesthesia between 9” and 11” ribs posteriorly on the Rt Side
Vague mass in Acute Cholecystitis is consisting of ……
- Inflamed gall bladder
- Omentum
- Inflammatory exudate
Vague Mass of acute cholecystits
- Surgical Importance
- Even if a perforation occurs, generalized peritonitis is uncommon.
DDx of Acute Cholecystitis
DDx of Acute Cholecystitis
- Perforated PU
DDx of Acute Cholecystitis
- Acute Pancreatitis
DDx of Acute Cholecystitis
- High Rectocecal Appendicitis
DDx of Acute Cholecystitis
- Amoebic Liver Abcess
DDx of Acute Cholecystitis
- Lobar Pneumonia (Basal)
- Can cause right hypochondriac guarding and rigidity.
- It is a referred pain.
Investigations for Acute Cholecystitis
- Lab
- Rad
Lab investigations of Acute Cholecystitis
- CBC
- Sugar Estimation
CBC in Acute Cholecystitis
Total WBC count is always raised
Sugar Estimation in Acute Cholecystitis
- Blood and urine
- To rule out diabetes mellitus
Imaging in Acute Cholecystitis
- X-ray
- US
- HIDA
- CT
X-Ray in Acute Cholecystitis
DDx of Radio-Opaque Shadow in X-Ray
Uses of US in Acute Cholecystitis
Emergency ultrasonography:
- In calculous cholecystitis: (Success rate is >95%)
- Acalculous cholecystitis
- Demonstration of Murphy’s sign
- Measure gall bladder function
- It can detect gall bladder polyps.
US in calculous cholecystitis
To demonstrate stones, which cast posterior acoustic shadow.
US in Acalculous cholecystitis
|t can demonstrate inflamed, thickened organ.
Demonstration of Murphy’s Sign in Acute cholecystitis
with the help of ultrasonography is possible which adds to the diagnosis.
Measure gall bladder function by US
By using ultrasonic dimensions of the gall bladder.
Importance of HIDA
- Diagnosis of acalculous cholecystitis .
- The diagnosis is i ndoubt
Method of HIDA
- IV administration of 99mTc labeled HIDA agent
- Then it is excreted in the biliary tree within one hour
Findings in HIDA
non-visualization of the gall bladder is diagnostic of acute cholecystitis.
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Explanation of HIDA
- The dye is excreted in the biliary tree & does not enter the gall bladder due to edema of the cystic duct.
Indications of CT in Acute Cholecystitis
When ultrasound findings are not clear
importance of CT in Acute Cholecystitis
Findings of CT in Acute Cholecystitis
TTT of Acute Cholecystitis
- Conservative
- Surgical
Conservative TTT of Acute Cholecystitis
Types of Cholecystectomy in Acute Cholecystitis
- Early
- Emergency
- Prophylactic
Def of Early Cholecystectomy in Acute Cholecystitis
cholecystectomy from the 2 day to the 7 day
Disadvantages of Early Cholecystectomy
Advantages of Early Cholecystectomy
Surgery can be done safely if
Incidence of Emergency Cholecystectomy
About 10% of cases of acute cholecystitis require emergency cholecystostomy.
Deciding Factors in Emergency Cholecystectomy
Other Indications of Emergency Cholecystectomy
- Acalculous cholecystitis.
- Perforated gall bladder with peritonitis.
Def of Prophylactic Cholecystectomy
Cholecystectomy for asymptomatic gall bladder stones.
Indications of Prophylactic Cholecystectomy
- Diabetic patients.
- Congenital hemolytic anemia.
- Patients undergoing bariatric surgery.
Prognosis of Acute Cholecystitis
Contriburing Factors to Death in Acute Cholecystitis
- Diabetes.
- age above 60 years.
- cardiovascular or pulmonary disease.
Def of Chronic Cholecystitis
Recurrent attacks of cholecystitis will convert the gall bladder into a fibrosed, nonfunctioning, contracted, shrunken, small gall bladder
Pathology of Chronic Cholecystitis
CP of Chronic Cholecystitis
Present with classical fatty food intolerance
Dx of Chronic Cholecystitis
TTT of Chronic Cholecystitis
Cholecystectomy
Def of Mucoscele
A stone blocking the cystic duct and the bile is not infected.
Pathophysiology of Mucoscele
CP of Mucoscele
TTT of Mucoscele
Cholecystectomy
Incidence of Empyema & Perforation of GB
Uncommon
PPT Factors For Empyema & Perforation of GB
CP of Empyema & Perforation of GB
Patients present with
1. High-grade fever with chills and rigors
2. Toxicity
3. High leukocyte count.
Types of Empyema & Perforation of GB
Localized perforation with pericholecystic abscess
Free perforation into the general peritoneal cavity
Done
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