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    Acute Cholecystitis

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    denanddon99
    Acute cholecystitis is an inflammation of the gallbladder that is usually caused by a gallstone blocking the cystic duct. It can occur due to a bacterial infection traveling through the bloodstream and settling in the gallbladder. Common bacteria that cause acute cholecystitis include E. coli, Klebsiella, and Salmonella. Symptoms include pain in the upper right abdomen, fever, nausea, and tenderness over the gallbladder. Diagnosis is typically made using ultrasound and blood tests. Treatment involves antibiotics, pain medications, and in severe cases, emergency surgery to remove the gallbladder.

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    Acute Cholecystitis

    Uploaded by

    denanddon99
    16 views10 pages
    Acute cholecystitis is an inflammation of the gallbladder that is usually caused by a gallstone blocking the cystic duct. It can occur due to a bacterial infection traveling through the bloodstream and settling in the gallbladder. Common bacteria that cause acute cholecystitis include E. coli, Klebsiella, and Salmonella. Symptoms include pain in the upper right abdomen, fever, nausea, and tenderness over the gallbladder. Diagnosis is typically made using ultrasound and blood tests. Treatment involves antibiotics, pain medications, and in severe cases, emergency surgery to remove the gallbladder.

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    Acute cholecystitis is an inflammation of the gallbladder that is usually caused by a gallstone blocking the cystic duct. It can occur due to a bacterial infection traveling through the bloodstream and settling in the gallbladder. Common bacteria that cause acute cholecystitis include E. coli, Klebsiella, and Salmonella. Symptoms include pain in the upper right abdomen, fever, nausea, and tenderness over the gallbladder. Diagnosis is typically made using ultrasound and blood tests. Treatment involves antibiotics, pain medications, and in severe cases, emergency surgery to remove the gallbladder.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    16 views10 pages

    Acute Cholecystitis

    Uploaded by

    denanddon99
    Acute cholecystitis is an inflammation of the gallbladder that is usually caused by a gallstone blocking the cystic duct. It can occur due to a bacterial infection traveling through the bloodstream and settling in the gallbladder. Common bacteria that cause acute cholecystitis include E. coli, Klebsiella, and Salmonella. Symptoms include pain in the upper right abdomen, fever, nausea, and tenderness over the gallbladder. Diagnosis is typically made using ultrasound and blood tests. Treatment involves antibiotics, pain medications, and in severe cases, emergency surgery to remove the gallbladder.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 10

    Acute cholecystitis

    Acute cholecystitis :- inflammation of gallbladder.


    • It occurs in patient with pre-existing chronic cholecystitis.
    Classification
    1. Acute calculous cholecystitis
    2. Acute acalculous cholecystitis
    Mode of infection
    • Haematogenous through hepatic artery (cystic artery)
    • Portal vein
    • Through bile after filtering in the liver via portal circulation.
    Causative organisms :-
    1. E.coli (most common)
    2. Klebsiella , pseudomonas , proteus
    3. Salmonella
    4. Clostridium welchii
    Pathogenesis :-
    • Lumen contains infected bile/fluid.
    • Mucosa shows ulceration & necrosis.
    • Submucosa :- necrosis and infection.
    • Area of necrosis and patchy gangrene.
    • Gallbladder distended with oedematous
    friable wall containing dilated vessels.
    Clinical features :-
    • Sudden onset of pain in right hypochondrium with tenderness ,
    guarding/rigidity.
    • Palpable soft gallbladder
    • Fever , nausea, palpable tender mass in gallbladder region (25%).
    • Boas’s sign :- area of hyperaesthesia between 9th and 11th rib posteriorly
    extending 2.5cm lateral to spinous process of vertebrae on right side.
    • Murphy’s sign :- Ask patient to take deep breath while exerting moderate
    Pressure over right upper quadrant , patient catches breath as inflamed
    gallbladder pushed down by diaphragm gets imposed against thumb.
    Investigations :-
    • USG – more than 4mm thickness of
    gallbladder wall.
    - presence of absence of gallstones.
    • Plane X- ray abdomen
    • Neutrophilia in blood examination. Calculous cholecystitis

    • HIDA scan – non visualisation of


    gallbladder is diagnostic.

    Normal
    HIDA scan
    • CT scan for identifying
    perforation ,impacted stones ,
    gallbladder thickness and oedema.

    • LFT – increase serum bilirubin often


    signifies cholangitis / stones in CBD.
    D/D :-
    • Duodenal ulcer perforation
    • Acute pancreatitis
    • Acute pyelonephritis
    • Acute appendicitis
    • Lobar pneumonia ,MI .
    • Ruptured ectopic pregnancy
    Complications :-
    1. Perforation (5-10%) lead to cholecystoduodenal,cholecystobiliary,
    cholecystointestinal fistula ,mirrizi’s syndrome.
    2. Peritonitis, pericholecystitic abscess.
    3. Cholangitis, septicaemia
    4. Empyema gallbladder, gangrenous bladder.
    Treatment :-
    • Advised hospitalisation.
    • Initially conservative treatment (95%)
    1. Nasogastric aspiration
    2. Iv fluids
    3. Analgesics and antispasmodics
    4. Broad spectrum antibiotics (ceftazidime, ceftriaxone, cefotaxime+amikacin,
    tobramycin+metronidazole).
    5. Observation and follow-up for US scans.
    Pt present within 72 hrs of attack Pt present after 72 hrs of attack

    Conservative management followed by same Conservative management followed by interval


    sitting laparoscopic cholecystectomy laparoscopic cholecystectomy after 4 -6 weeks
    (due to vascular adhesions increase risk of
    bleeding)
    Indications for emergency cholecystectomy:-
    • Empyema gallbladder
    • Persisting symptoms or failure of medications.
    • Emphysematous cholecystitis
    • Perforation and peritonitis.
    The gallbladder is opened and all stones and pus are
    removed
    Either foley’s or malecot’s catheter is placed in
    gallbladder and exteriorised.
    • After 3 weeks elective cholecystectomy is done.
    THANK YOU

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