This document discusses cholecystitis, inflammation of the gallbladder. It notes that gallstones are the most common cause of cholecystitis, occurring in 98% of cases, with obstruction of the cystic duct and inflammation due to gallstones being the typical pathogenesis. Ultrasound is identified as the initial diagnostic study of choice for gallbladder disease. Treatment involves IV fluids, analgesia, antibiotics, and cholecystectomy, with laparoscopic cholecystectomy being the gold standard procedure.

1. Cholecystitis
Adeel Abbas Dhahri
Nourelhuda Darwish

3. Hartmann pouch?

7. Contents of Bile

10. What is the initial diagnostic study of choice for GB disease?
98% efficient

12. Cholelithiasis
• Incidence  10%
• 80% asymptomatic
• 4 Fs ;
• Female
• Fat
• Forty
• Fertile

13. Presentation of GS Disease?
• Biliary Colic
• Gallstones
• Acute Cholecystitis
• Choledocholithiasis
• Acute cholangitis
• Acute Pancreatitis
• Gallstone Ileus
• Mucocele / Empyema

15. Difference between Colic and Biliary Colic

16. How do you diagnose Cholelithiasis?
• History
• Clinical examination
• Ultrasound examination

17. Acute Cholecystitis

18. Pathogenesis
• Obstruction of cystic duct  Inflammation
• Risk Factor is Gallstone
• 5% without any evidence of gallstones
• Likely due to;
• Biliary stasis
• Sludge
• Gallbladder disuse (absence of CCK)

19. Clinical Features?

20. Clinical Features

21. What next?
• Ultrasound Scan

22. What next?
• FBC
• Raised WCC
• LFT
• Slightly raised ALP, T. Bilirubin, Amylase
• RFT
• Coagulation profile

23. Complications?
• Empyema
• Gangrenous
• Perforation
• Abscess
• Chronic Cholecystitis
• Cholecyst-enteric Fistula

24. Treatment?
• IV Fluids
• Analgesia
• Antibiotics
• Cholecystectomy
• Gold Standard is Laparoscopic Cholecystectomy

25. Which artery is susceptible to injury during cholecystectomy?

26. Acute Acalculous Cholecystitis
• Risk Factor?
• Prolonged fasting
• Trauma
• TPN
• Multiple transfusion
• Dehydration
• Prolonged PostOp period
• Investigation of Choice?
• Ultrasound
• HIDA scan
• Treatment?

27. Recap

28. • What are the features of Acute Cholecystitis?
• What is the pathogenesis of Acute Acalculous Cholecystitis?
• What is the diagnostic test of choice for acute cholecystitis?
• What are the features of Acute Cholecystitis on Ultrasound?

29. • What is the treatment of Acute Cholecystitis?
• What are the boundaries of Calot’s Triangle?
• What is the pathogenesis of Acute Acalculous Cholecystitis?
• What are the risk factors for developing Acute acalculous
cholecystitis?