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Acute cholecystitis

Acute cholecystitis






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    Acute cholecystitis Acute cholecystitis Presentation Transcript

    • Acute cholecystitis Dr/ Hytham Nafady
    • Etiology
    • U/S • Stones (echogenic with back shadow). • Stone impacted in cystic duct. • Sludge. • Gall bladder distension • Mural thickening > 3 mm. • Mural haziness (poor definition). • Mural striations (3 layered appearance with sonolucent middle layer due to edema). • Peri-cholecystic fluid collection. • Sonographic Murphy’s sign.
    • Stones Stone at fundus Obstructing stone at gall bladder neck
    • Sludge
    • Mural thickening
    • Duplex Hypervascularity of the gall bladder wall
    • CT 1. Stones. 2. Gallbladder distension (> 5 cm in transverse diameter). 3. Mural thickening. 4. Mural hyper-enhancement. 5. Peri-cholecystic fluid collection. 6. Peri-cholecystic inflammatory fat stranding. 7. Enhancement of the adjacent liver parenchyma due to reactive hyperaemia.
    • Reactive hyperemia of the adjacent liver parenchyma
    • MRCP • Impacted stone at the gall bladder neck or cystic duct. • The stone appears as a filling defect of signal void withing the high signal intensity bile.
    • HIDA scan • Non visualized gall bladder after 60 minutes. Causes of false positive HIDA scan: Total parentral nutrition (fasting). Sphincerotomy. Sever liver disease.
    • Dilated cardiomyopathy with hepatic congestion & gall bladder wall thickening
    • Gall bladder mural thickening in a patient with pancreatitis
    • Complication Definition Signs Emphysematous cholecystitis Acute cholecystitis, with secondary infection of the gall bladder wall. Intramural or intraluminal air. Hemorrhagic cholecystitis Acute cholecystitis, with intraluminal hemorrhage. Intraluminal hemorrhage. Gangrenous cholecystitis Acute cholecystitis, with ishemia & necrosis of the gall bladder wall. Mucosal defects. Sloughed membrane. Gall bladder perforation Acute. Acute peritonitis. Subacute. Pericholecystic abscess. Chronic. Internal biliary fistula. Vascular complications Cystic artery pseudo- aneurysm. Portal vein thrombosis.
    • Gangrenous cholecystitis
    • Sloughed membrane Sludge
    • stone Hemorrhagic cholecystitis
    • Hemorrhagic cholecystitis
    • Emphysematous cholecystitis
    • U/S • Sagittal sonogram shows a curvilinear echogenic interface in the gallbladder fossa with reverberation artifact
    • Supine view
    • Upright view CT
    • Gall bladder perforation
    • Subacute perforation (contained peforation) Pericholecystic abscess defect
    • Subacute perforation (contained peforation) Pericholecystic abscess defect
    • Cholecysto-enteric fistula BL = dilated loops of proximal small intestine
    • Gall stone ileus
    • Cholecystoenteric fistula & gall stone ileus
    • Cholecysto-duodenal fistula
    • Bouveret syndrome duodenal obstruction by a gall stone
    • Cystic artery pseudo-aneurysm
    • Portal vein thrombosis
    • DD of Rt upper quadrant pain • Acute cholecystitis. • Acute pancreatitis. • Hepatitis. • Acute right pyelonephritis. • Perforated duoedenal ulcer.