Acute Cholecystitis

 

  • Symptoms of acute cholecystitis
  • – Acute attack of biliary pain that progressively worsen
  • – Most have previous episode of biliary pain
  • – Nausea ,vomiting
  • – Peritoneal signs of inflammation
  • – RUQ tenderness
  • – Murphy’s sign
  • – Low grade fever
  • – Shaking chills and rigor

 

  • Cause:
  • – 90% cases occur due to transient or permanent obstruction of the cystic duct by a stone. It represents inflammatory response to mechanical, chemical or bacterial causes. Increased intraluminal pressure causes ischemia of the gall bladder
  • – Bacterial inflammation plays a role in 50-85% acute cholecystitis cases
  • – Enlarged, tender, palpable GB present in 1/3rd acute cholecystitis patients often associated with a stone in the neck of the GB

 

  • Investigations:
  • – Leukocytosis
  • – Mildly elevated S. bilirubin , liver enzymes

 

  • Complications of acute cholecystitis
  • – 10-30% patients develop complications of acute cholecystitis
  •           Gall bladder gangrene
  •           Empyema GB
  •           Perforation of GB
  •           Fistula ( 60% fistula located between GB and duodenum)

 

Management of Acute Cholecystitis

  • – NPO and I.V hydration
  • – Broad spectrum I.V antibiotic
  • – Ideally, elective laparoscopic cholecystectomy within 24 hours of admission
  •  *75% patients recover by conservative therapy
  •  *20% recurrence within 1 year

 

  • Emergency operation if
  • – Suspected perforation
  • – Gangrene
  • – Empyema

 –  If cholecystectomy cannot be done within 1-5 days due to late diagnosis or other medical reasons (high operative risk) it is generally performed within 6 weeks


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