L12: Cholecystitis Flashcards by Ahmed Farag | Brainscape

Q

Def of Cholecystitis

A

Acute bacterial inflammation of the gall bladder with or without stone

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Q

Types of Cholecystitis

Def of Acute Cholecystitis

A

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Q

Majority of calculous acute cholecystitis are due to organisms such as ……

A

E. coli
Salmonella
Streptococci
Klebsiella, etc.

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Q

Typhoid & acute Cholecystits

A

Typhoid fever: can also cause Typhoid Cholecystitis around 2nd week of infection.

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Q

Clostrium & acute Cholecystitis

A

Clostridial infection of the gall bladder produces acute cholecystitis with toxemia.

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Q

Pathogenesis of Acute Cholecystitis

A

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Q

Type of Patient in Acute Cholecystitis

A

fatty, fertile, female

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Q

Acute Cholecystitis in a young boy?

A

You may be surprised to find a young boy, a girl or even a child with gall stones suspect hemolytic anemias.

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Q

CP of Acute Cholecystitis

A

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Q

Signs in Acute Cholecystitis

A

Murphy Sign
Boas’ Sign
Vague Mass
Upper abdominal guarding, rigidity

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Q

Importance of Murphy sign

A

Is a diagnostic sign of acute cholecystitis

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Q

Technique of Murphy sign

A

1) Keep the fingers in the right hypochondrium.

2) Ask the patient to take a deep inspiration.

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Q

Result of Murphy sign

A

+ve murphy’s sign

At the height of inspiration there is a sudden catch in the inspiration.

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Q

Explanation of Murphy sign

A

It is due to inflamed gall bladder coming in contact with the abdominal wall under the fingers & producing pain.

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Q

Boas’ Sign

A

An area of hyperaesthesia between 9” and 11” ribs posteriorly on the Rt Side

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Q

Vague mass in Acute Cholecystitis is consisting of ……

A

Inflamed gall bladder
Omentum
Inflammatory exudate

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Q

Vague Mass of acute cholecystits

Surgical Importance

A

Even if a perforation occurs, generalized peritonitis is uncommon.

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Q

DDx of Acute Cholecystitis

A

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Q

DDx of Acute Cholecystitis

Perforated PU

A

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Q

DDx of Acute Cholecystitis

Acute Pancreatitis

A

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Q

DDx of Acute Cholecystitis

High Rectocecal Appendicitis

A

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Q

DDx of Acute Cholecystitis

Amoebic Liver Abcess

A

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Q

DDx of Acute Cholecystitis

Lobar Pneumonia (Basal)

A

Can cause right hypochondriac guarding and rigidity.
It is a referred pain.

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Q

Investigations for Acute Cholecystitis

A

Lab
Rad

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Q

Lab investigations of Acute Cholecystitis

A

CBC
Sugar Estimation

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Q

CBC in Acute Cholecystitis

A

Total WBC count is always raised

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Q

Sugar Estimation in Acute Cholecystitis

A

Blood and urine
To rule out diabetes mellitus

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Q

Imaging in Acute Cholecystitis

A

X-ray
US
HIDA
CT

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Q

X-Ray in Acute Cholecystitis

A

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Q

DDx of Radio-Opaque Shadow in X-Ray

A

Q

Uses of US in Acute Cholecystitis

A

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.

Q

US in calculous cholecystitis

A

To demonstrate stones, which cast posterior acoustic shadow.

Q

US in Acalculous cholecystitis

A

|t can demonstrate inflamed, thickened organ.

Q

Demonstration of Murphy’s Sign in Acute cholecystitis

A

with the help of ultrasonography is possible which adds to the diagnosis.

Q

Measure gall bladder function by US

A

By using ultrasonic dimensions of the gall bladder.

Q

Importance of HIDA

A

Diagnosis of acalculous cholecystitis .
The diagnosis is i ndoubt

Q

Method of HIDA

A

IV administration of 99mTc labeled HIDA agent
Then it is excreted in the biliary tree within one hour

Q

Findings in HIDA

A

Q

non-visualization of the gall bladder is diagnostic of acute cholecystitis.

A

..

Q

Explanation of HIDA

A

The dye is excreted in the biliary tree & does not enter the gall bladder due to edema of the cystic duct.

Q

Indications of CT in Acute Cholecystitis

A

When ultrasound findings are not clear

Q

importance of CT in Acute Cholecystitis

A

Q

Findings of CT in Acute Cholecystitis

A

Q

TTT of Acute Cholecystitis

A

Conservative
Surgical

Q

Conservative TTT of Acute Cholecystitis

A

Q

Types of Cholecystectomy in Acute Cholecystitis

A

Early
Emergency
Prophylactic

Q

Def of Early Cholecystectomy in Acute Cholecystitis

A

cholecystectomy from the 2 day to the 7 day

Q

Disadvantages of Early Cholecystectomy

A

Q

Advantages of Early Cholecystectomy

A

Q

Surgery can be done safely if

A

Q

Incidence of Emergency Cholecystectomy

A

About 10% of cases of acute cholecystitis require emergency cholecystostomy.

Q

Deciding Factors in Emergency Cholecystectomy

A

Q

Other Indications of Emergency Cholecystectomy

A

Acalculous cholecystitis.
Perforated gall bladder with peritonitis.

Q

Def of Prophylactic Cholecystectomy

A

Cholecystectomy for asymptomatic gall bladder stones.

Q

Indications of Prophylactic Cholecystectomy

A

Diabetic patients.
Congenital hemolytic anemia.
Patients undergoing bariatric surgery.

Q

Prognosis of Acute Cholecystitis

A

Q

Contriburing Factors to Death in Acute Cholecystitis

A

Diabetes.
age above 60 years.
cardiovascular or pulmonary disease.

Q

Def of Chronic Cholecystitis

A

Recurrent attacks of cholecystitis will convert the gall bladder into a fibrosed, nonfunctioning, contracted, shrunken, small gall bladder

Q

Pathology of Chronic Cholecystitis

A

Q

CP of Chronic Cholecystitis

A

Present with classical fatty food intolerance

Q

Dx of Chronic Cholecystitis

A

Q

TTT of Chronic Cholecystitis

A

Cholecystectomy

Q

Def of Mucoscele

A

A stone blocking the cystic duct and the bile is not infected.

Q

Pathophysiology of Mucoscele

A

Q

CP of Mucoscele

A

Q

TTT of Mucoscele

A

Cholecystectomy

Q

Incidence of Empyema & Perforation of GB

A

Uncommon

Q

PPT Factors For Empyema & Perforation of GB

A

Q

CP of Empyema & Perforation of GB

A

Patients present with
1. High-grade fever with chills and rigors
2. Toxicity
3. High leukocyte count.

Q

Types of Empyema & Perforation of GB

A

Q

Localized perforation with pericholecystic abscess

A

Q

Free perforation into the general peritoneal cavity

A

Q

Done

A

..