Acute Cholecystitis

Introduction

-Acute cholecystitis is 90% calculous; 10% acalculous

-Cholecystitis is associated with gallstones occurs when a stone becomes impacted in the cystic duct and inflammation develops behind the obstruction.

-The acute attack is often precipitated by a large or fatty meal

Symptoms & Signs

-the sudden appearance of steady pain localized to the epigastrium or right hypochondrium, vomiting, fever, jaundice, muscle guarding, rebound tenderness

-Murphy sign: Positive when deep inspiration or cough during palpation of the RUQ produces increased pain or inspiratory arrest.

-In contrast to biliary colic of gallstone disease, the pain of acute cholecystitis does not subside. It is unremitting and may last for several days. It is usually more severe than the pain associated with uncomplicated gallstone disease.

-Peritonitis suggests gallbladder perforation.

-Emphysematous cholecystitis may produce abdominal wall crepitus.

Diagnosis

-Ultrasonography is considered the most useful initial radiologic test for diagnosing acute cholecystitis.  Findings suggestive of acute cholecystitis are gallbladder wall thickening, pericholecystic fluid, and a sonographic Murphy sign (Focal tenderness over the gallbladder when compressed by the sonographic probe (sonographic Murphy’s sign)

-HIDA Scan is useful in demonstrating an obstructed cystic duct

Labs: normal or elevated WBC,serum bilirubin levels, serum aminotransferase, alkaline phosphatase, serum amylase

Treatment

-All patients with acute cholecystitis should be hospitalized.

-They should receive IV fluids, broad-spectrum antibiotics, and analgesia.

-Cholecystectomy is the definitive treatment for acute cholecystitis.

 

Prognosis

-Excellent after cholecystectomy

Complications: Empyema, hydrops, gangrene, perforation, fistulization, gallstone ileus, porcelain gallbladder.

-Mirizzi syndrome: A stone in the neck of the gallbladder may compress the common hepatic duct and cause jaundice

  1. What is the procedure of choice for acute cholecystitis? Laparoscopic cholecystectomy
  2. What is the most frequent complication of acute cholecystitis? Gangrene.
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