Acute Cholecystitis

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  • 1.
    • Acute Cholecystitis
  • 2. Acute cholecystitis occurs in approximately one third of patients with gallstones and is caused by obstruction of the cystic duct by an impacted calculus. This results in gallbladder wall inflammation which may lead to infection and necrosis.
    • Acute Cholecystitis
  • 3. Acute Cholecystitis
    • The diagnostic criteria include cholelithiasis, sonographic Murphy's sign with maximal tenderness over the sonographically localized gallbladder, gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation.
  • 4. Symptoms and Signs
    • Most patients have had prior attacks of biliary colic or acute cholecystitis. The pain of cholecystitis is similar in quality and location to biliary colic , severe. Vomiting is common, as is right subcostal tenderness. Within a few hours, Murphy's sign develops along with involuntary guarding of right-sided, upper abdominal muscles. Fever, usually low grade, is common .
  • 5. Investigations
    • Blood
    • Laboratory values alkalinephosphatase (30 to 120 IU / L) ,possibly anelevated bilirubin ( TBIL 2 - 14 μ mol / L ,DB 0 - 4 μ mol / L ) and possibly an elevation of the WBC count (normally between 4×10 9 - 1.1×10 10 ) . The degree of elevation of these laboratory values may depend on the degree of inflammation of the gallbladder.
  • 6. Investigations
    • Radiology
    • Ultrasound is a sensitive and specific modality for diagnosis of acute cholecystitis; . The 2 major diagnostic criteria are cholelithiasis and sonographic Murphy's sign . Minor criteria include gallbladder wall thickening greater than 3mm, pericholecystic fluid, and gallbladder dilatation .
  • 7. Investigations
    • CT SCAN
    • The reported sensitivity and specificity of CT scan findings are in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and calculi outside the lumen of the gallbladder.
  • 8.
    • Image 1 (Ultrasound): Grossly thickened gallbladder wall, with calculi (arrow) within the gallbladder and pericholecystic fluid.
  • 9. Treatment
    • Cholecystectomy
    • Traditional open cholecystectomy is a major abdominal surgery in which the surgeon removes the gallbladder through a 10 to 18 cm ( 4- to 7-inch ) incision . Patients usually remain in the hospital overnight and may require several additional weeks to recover at home . It takes a minimum of 7 to 15 days to complete the treatment . or as long as 30 days
  • 10. Treatment
    • Laparoscopic Cholecystectomy
    • the first - choice of treatment for gallstones and inflammation of the gallbladder.laparoscopic approach requires several small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5-10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity .
  • 11. Treatment
    • Nonsurgical treatment
    • includes pain medicines, antibiotics to fight infection, and a low - fat diet