ACUTE CHOLECYSTITIS

DEFINITION
Inflammation of gall bladder is
called ACUTE CHOLECYSTITIs
INCIDENCE
COMMON IN FERTILE

FATTY

ABOVE FORTY

FEMALES
lydia shum
 Etiology

Obstruction
Bacterial invasion
Trauma and chemical irritation
Pancreatic reflex
 Etiology
1 CALCULOUS
 etiology
2 ACALCULOUS
Cholesterosis(strawberry gall
bladder)
Cholesterol polyposis of gall bladder
Cholecystitis glandularis proliferans
Diverticulosis of gall bladder
Typhoid of gall bladder
 etiology
BACTERIAL INFECTION
E-coli
Klebsiella
S.faecalis
Salmonella
Clostridia Anaerobes
classification
On etiology:
calculous,acalculous,emphysamatous
On inflammation:simple,destructive

Emphysamatous
classification
On morphology:
catarhal,phlegmonous,gangrenous,gan
grenous perforation
Clinical Findings
Symptoms:
1. Abdominal pain
Where
When
How
Abdominal pain

SITE - RIGHT HYPOCHONDRIUM

TYPE - COLICKY
ONSET SUDDEN
DURATION MORE THAN 12 hrs
RADIATION
BACK
SHOULDER
RIGHT HYPOCHONDRIUM
LEFT HYPOCHONDRIUM
Symptoms:

2 gastrointestinal
Nausea, bilious vomiting
Abdominal distension
Belching or flatulence
3. Fever
Acute cholecystitis in
elderly and old patients
is characterized by
quickly developing
intoxication syndrome
 signs
GENERAL
TACHYCARDIA
PYREXIA

From MMWR
Aug 2004
 Local
TENDERNESS - RT
HYPOCHONDRIUM
RIGIDITY - RT HYPOCHONDRIUM
MURPHYS SIGN
BOAS SIGN
MASS
From MMWR
Aug 2004
murphys sign
 Boas sign
An area of hyperasthesia between 9 th
and 11th rib posteriorly right side is a
feature
Laboratory findings
Elevated leukocyte count

Elevated serum bilirubin

Elevated amylase level

 Instrumental investigation
PLAIN X-RAY ABDOMEN

Radioopaque gall stone

 ULTRASONOGRAPHY
Dilatation of billiary tree
Stones
Fluid
Common bile duct dialation
Intra hepatic duct dialation
Gall stone
GALL BLADDER RADIONUCLIDE SCAN

ORAL CHOLECYSTOGRAM

PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY (PTC)

ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP)

MAGNETIC RESONANCE
CHOLANGIOPANCREATOGRAPHY (MRCP
 HIDA SCAN

HIDA IS HEPATIC IMINODIACETIC ACID

HIDA SCAN SHOWING NONVISUALIZATION OF GALL BLADDER
ERCP showing mirizzi
syndrome
 complication
EMPYEMA
PERFORATION
PERITONITIS
ABSCESS
FISTULA
MUCOCELE
ACUTE PANCREATITIS
GALL STONE ILEUS
OBSTRUCTIVE JAUNDICE
Treatment
Nonsurgical or preoperative
management
Intravenous fluids
Nasogastric tube
Broad spectrum antibiotics
 Naspgastric tube:
ryles tube admistration immediately
continued 3 to 5 days.aspirating HCL
decreases the secretion of bile.spasm of
bladder may come down
intravenous fluid:
in the beginning 5 % dexrose saline
may be started but subsquently fluid may be
changed according to electrolyte balance of
paitent
Analgesic +anticholinergic given to reduce
spasm
Antibiotic

broad spectrum to cotrol

inflammation.combination of
ampicillin+clindamycin+ and
aminoglycoside is good.
 Conservative treatment stopped
and early cholecystectomy
advised
1)pain and tenderness spread across the
abdomen
2)gall bladder increases in size
3)Pulse rate continuse to rise
4)In very elderly patient
 Surgical Treatment
1.Attack within 48-72 h of diagnosis
2.Deterioration in patients general condition
3.Complications are present
Perforation
Peritonitis
Acute obstructive suppurative cholangitis
Acute pancreatitis
 Surgical methods
Open cholecystectomy
Laparoscopic cholecystectomy
 Two method in cholecystectomy:
duct first method:
the cystic duct and artery are
first dissected and divided
fundus first method:
in which dissection is started
from fundus and gradually proceed
toward cystic duct
 Operative problems
1)CBD and right hepatic artery
injury during the operation of
fundus first method

2)Slipped of clip or ligature may

lead to profuse bleeding
3)Biliary leakage from some unknown
duct which may lead to syndrome
known as waltman-walter syndrome
this syndrome is menifested by
chest pain or upper abdominal
pain,low BP,tachycardia.it mimics
coronory thrombosis,pulmonary
embolism.this condition is fatal so
immediately reexplored the
abdomen
Postoperative treatment

1)Drainage is removed after 48 hours or it

may be kept for longer period
2)Gastric aspiration and IV fluid is
continued until the peristalsis of
intestine is come back
 THANK U
AO