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Acute and Chronic Cholecystitis
- 1. Acute and Chronic Cholecystitis Dr.SujithMathew Jose PG in General Surgery Coimbatore Medical College Coimbatore
- 3. Acute Cholecystitis Occurs in 1.Patientswith pre existing chronic cholecystitis 2.As first episode Most Common Cause Impacted Gallstone in Hartmann’s Pouch
- 4. • Temporary impaction –Only Biliary Colic – No INFLAMMATION • Prolonged impaction – INFLAMMATION ENSURES – Edema of GB – Subserosal Hemorrhage ACUTE CHOLECYSTITIS
- 5. Causitive Organisms: • EColi (most common) • Klebsiella,Pseudomonas,Proteus • Strep.Faecalis • Salmonella • Clostridium Welchii
- 6. Classification • Acute CalculousCholecystitis • Acute Acalculous Cholecystitis
- 7. Mode of Infection A.Hematogenous Hepatic Artery Cystic Artery A. Portal Vein B. Through Bile
- 8. Pathogenesis • Stone causesObstruction at hartmann’s pouch or in cystic duct • Obstruction causes Stasis • It leads to Edema of the wall • Bacterial Infection occurs • Leads to Acute Cholecystitis
- 9. Impacted Stone --mucosal erosion Thereby Bile Salts will act on Submucosal tissue Bile is toxic to tissues Leads to Necrosis, Infection and Perforation
- 11. Presentation SYMPTOMS FEVER RIGHTUPPER QUAD PAIN NAUSEA
- 12. SIGNS RIGHT UPPERQUAD TENDERNESS GUARDING RIGIDITY MURPHY’S SIGN (arrest of inspiration with gentle pressure under the R costal margin due to tenderness) BOAA’s SIGN- Hyperasthesia at 9th to 11th rib posteriorly on R side PALPABLE TENDER GALLBLADDER TACHYCARDIA
- 14. INVESTIGATIONS • LAB STUDIES •LEUKOCYTOSIS • Mild elevation of BILIRUBIN , ALP, SGOT/PT If Profound Jaundice + Picture of Acute Cholecystitis Suspect, CHOLANGITIS with obstruction of CBD MIRIZZI syndrome
- 15. USG • Sensitive • Inexpensive •Reliable » Sensitivity 85% and Specificity 95% What will you look in USG? 1.GallStone 2.Pericholecystic fluid 3.GB wall thickening 4.Sonographic murphy’s sign
- 16. Accurate History Physical Examination SupportiveLab Studies And an Ultrasound Needed in most of the cases for Diagnosis Extras HIDA Scan CT Scan
- 17. • Remember CT isless sensitive than USG for the diagnosis of Acute Cholecystitis
- 18. Management of AcuteCholecystitis 1. NPO 2. RYLES TUBE ASPIRATE 3. IV Fluids 4.BROAD SPECTRUM ANTIBIOTICS 5.IV ANALGESICS 6. OBSERVATION
- 19. Surgery in a/cCholecystitis When presents within 2 to 3 days LAP CHOLECYSTECTOMY When presents more than 3 days INTERVAL CHOLECYSTECTOMY after 6 weeks In Pregnancy CHOLECYSTECTOMY @ T2 Empyema, Persisting and Progressing Symptoms EMERGENCY CHOLECYSTECTOMY
- 20. Complications PERFORATION PERITONITIS PERICHOLECYSTIC ABSCESS CHOLANGITISand SEPTICEMIA PANCREATITIS EMPYEMA GB GANGRENOUS GB
- 21. Acute Acalculous Cholecystitis •5% • ICU patients, Post OP patients, Burns, Cholecystoses • Gallbladder distension, release of Factor VII • Acute Presentation • Rx – Cholecystectomy
- 22.
- 23. Causes • GALL STONES •CHOLECYSTOSIS • CHRONIC ACALCULOUS CHOLECYSTITIS Organisms: Klebsiella Steptococci Salmonella
- 24. Pathology • GB isshrunken, contracted,small, nonfunctioning, fibrotic with thickened GB wall Mucosa proliferates into Lumen ROKITANSKY ASHCHOFF SINUSES Muscular wall replaced by Fibrotic tissue
- 25. Clinical Featues • ColickyPain • Murphy’s Sign • Dyspeptic Symptoms • Intolerance to fatty meal
- 26. Complications • CBD Stones •Cholangitis • Pancreatitis • Mirizzi’s Syndrome
- 27. Treatment of ChronicCholecystitis is CHOLECYSTECTOMY
- 28.