Cholecystitis causes symptoms management by almas khan Roghani fb/ almas khan Roghani

1. Prepared by: Almas khan

2. Definition
Types
Causes
Clinical features
Investigations
Complication
Differential diagnosis
Management

3. Cholecystitis is an inflammation of the
gallbladder.
gallbladder is a small, pear-shaped organ on
the right side of your abdomen, beneath your
liver. The gallbladder holds a digestive fluid
that's released into your small intestine (bile)

4. 1 .. Calculus: it’s obstructive type & 90%
occur due to gall stones.
2 .. Acalculus: its non obstructive types occur
in critically ill patients like burn , severe sepsis ,
shock,DM,etc
3... Acute emphysematous cholecystitis
is an uncommon condition caused by gas-
forming organisms and characterized by the
presence of gas in the wall and lumen of
the gall bladder.

5. •Gall stones : 90%
•Tumor
•Bile duct blockage
•Infection :
AIDS and certain viral infections can trigger
gall bladder inflammation.
•Blood vessel problems:
A very severe illness can
damage blood vessels and decrease blood flow to the
gallbladder, leading to cholecystitis.

6. •E.Coli
•Klebsiella
•Streptococcus fecalis
•Anarobs

7. 1…Pain
•Onset : it may be sudden in onset or
superimposed on the pain of chronic
cholecyctitis usually participated by large or
fatty meal
•Site : epigastrium or right hypochondria
•Radiation :it radiates through the trunk to the
tip of the right scapula
•Aggressive factors: movement and breathing
•Relieving factors: no except analgesic

8. 2.. Nausea
3.. Vomiting
4.. Anorexia
5.. Sweating
6.. Chills
7.. Bloating

9. On examination
•Patient anxious ,lying quietly with shallow
breathing
•Tachycardia
•Tenderness
•In severe case there may be palpable inflammatory
mass around gall bladder
•Jaundice in 25 % cases

10. •Boas’s sign : the area below the scapula at 9,10,11
rib become hypersensitive
•Murphy sign: Murphy's sign is elicited in patients
with acute cholecystitis by asking the patient to
take in and hold a deep breath while palpating the
right sub costal area. If pain occurs on inspiration,
when the inflamed gallbladder comes into contact
with the examiner's hand, Murphy's sign is positive

11. Blood CP: TLC raised (12000-15000)
LFTs : Raised serum ALT ,AST and
Alkaline phosphates
Ultrasound : show Gall stones
HIDA scan: cystic duct obstruction
CT Scan

12. Perforated peptic ulcer
Acute pancreatitis
Colon CA
Liver Abscess
Hepatitis
Basal pneumonia with pleurisy

13. oChronic cholecystitis
oCholangitis
oEmpyema (pus in the gallbladder)
oGangrene
oPerforation of GB
oPancreatitis
oPeritonitis

14. Conservative management consist of 3A
1)Aspiration:
nasogastric aspiration and iv fluids
2)Analgesics:
pentazocine, Meperidine
3) Antibiotics :
Inj cefuroxime 1.5g iv 8 hourly +
Inj Metronidazole 500mg 8 hourly

15. Cholecystectomy: removel of GB
•Open cholecystectomy
or
• laparoscopic
cholecystectomy