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ACUTE CHOLECYSTITIS

Assistant professor :
pechyonkin

Student: raza sarif
Group : 414 A
DEFINITION
Inflammation of gall bladder is
called ACUTE CHOLECYSTITIs
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
MURPHY’S SIGN
BOAS SIGN
MASS
From MMWR –
Aug 2004
murphy’s sign
Boas sign
• An area of hyperasthesia between 9th
and 11th rib posteriorly right side is a
feature
Ortner sign
Kera sign
• Mussi sign
• Shotkin blumber sign
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
Acute cholecystitis..
Acute cholecystitis..
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

due to edema of cystic duct HIDA
Does not enter in gall bladder hence
nonvisualization of gall bladder is
diagnostic of acute cholecystitis
Its imortance lies in diagnostic of
acalculous cholecystitis
HIDA SCAN SHOWING NONVISUALIZATION OF GALL BLADDER
ERCP showing mirizzi
syndrome
DIFFERENTIAL DIAGNOSIS

common





ACUTE PANCREATITIS
PERFORATED DUODENAL ULCER
PERFORATED PEPTIC ULCER
APPENDICITIS
RARE
ACUTE PYELONEPHRITIS
HEPATITIS
MYOCARDIAL INFARCTION
PNEUMONITIS
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:
ryle’s 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 patient’s 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
СПAСИБO

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Acute cholecystitis..