ACUTE CHOLECYSTITIS CAUSES AND TREATMENT

ACUTE CHOLECYSTITIS CAUSES AND TREATMENT

ACUTE CHOLECYSTITIS

Definition

That is mean acute or sudden inflammation or infection of the gall bladder which may due to stones in the gall bladder or other causes rather than stones

Types

    

 There are two types either

Acute calcular (stone ) cholecystitis  about 95% also called 

 acute obstructive cholecystitis

Acute non calcular( no stones) cholecystitis about 5% also called acute non obstructive cholecystits

What are the micro-organsims responsible for the infection of the gall bladder

Most common E. coli also klebsiella streptococcus faecalis gas forming organisms eg clostridia welchii these organisms are present normally in biliary system

Symptoms of acute cholecystitis

• Pain in the form of biliary colic  which is severe praoxysmal pain the patient feel it in the right upper quadrant of the abdomen (right hypochondrium) and epigastric region and the pain often radiate to the right shoulder and the right scapular area
• The pain is accompanied by severe nausea anorexia and vomiting and the patient become unrest
• Most of the patient give a history compatible with chronic cholecystitis
• In contrast to biliary colic the pain of acute cholecystitis does not subside and may persist for several days
• When infection occurs the pain lose its paroxymal nature and become continuous throbbing and increased by movement cough and deep breathing
• The temperature rises often with rigors and sweating 

Signs of acute cholecystitis

• General signs in the form of  high temperature (fever) increase heart rate (tachycardia) the tongue become coated 
• Jaundice may appear due to stone in the hartmann,s pouch pressing the common hepatic duct or mirizzi,s syndrome or associated stone in common bile duct or associated cholangitis
• Local signs limited abdominal movement with respiration in the right upper quadrant (right hypochondrium
• Tenderness and rigidity in right hypochondrium
• Boas,s sign area of hyperaesthesia between the 9th and 11 th ribs posteriorly on the right side
• Palpable gall bladder may be present in case of empyema( pus) of gall bladder or mucocele( serous) of gall bladder
• Murphy,s sign an inspiratory arrest with deep palpation in the right subcostal area is characteristic of acute cholecystitis

Investigations of acute cholecystitis

Laboratory

Full blood count

showing moderate or high leucocystosis

Liver function test

Showing bilirubin level

  Urine analysis

 Showing there is bilirubin or urobilinogen

 

Imaging study

Ultrasound

Abdominal ultrasound  very good to diagnosis

CT scanning very good

MRI scanning very good

Radioisotope scanning (HIDA) scanning

HIDA scan is imino diactetic acid and are excreted in the bile and are used to visualize the biliary tree and showing the patency of the cystic duct

For more details about investigations see here

Treatment of acute cholecystitis

Medical and conservative treatment

• Rest in bed in the smisitting position to relax abdominal wall and to decrease intra abdominal pressure and to drainage pus in the pelvis if ruptured or perforation of gall bladder occurred which is very rare  because the gall bladder is capacious and distensible organ and has good blood supply and also due to thickened wall of gall bladder due to chronic cholecystitis common site of gall bladder perforation are the fundus which is far away from blood supply or at the neck of gall bladder from pressure necrosis of an impacted stone
• Antibiotic to guard against infection
• Good analgesics to relieve the pain
• Intravenous fluids like glucose normal saline ringers lactate
• Nothing is given by mouth these all to rest the inflammed gall bladder  and pancreatic systems by gastric aspiration these measures are continuous till the symptoms and signs of acute cholecystitis are subside may for 3-5 days
• Hot fomentation to the right upper quadrant of the abdomen( right hypochondrium) and kaoline poultice 
• After the symptoms and signs of acute inflammation are subsides in the form of the temperature the pulse become normal the pain are improved the patient start oral fluid

Surgical treatment

Indications

• Failure of medical treatment with the following conditions spreading peritonitis jaundice become increased an abscess pointing externally or increase in size
• Other indications some prefer to do surgical operation without conservative treatment after preparation of the patient by parenteral fluid gastric suction and antibiotic these opinion consider that in early phase of acute cholecystitis  the adhesion around gall bladder are fibrinous and easy to remove  also some case may not respond to conservative treatment and may become worse and also to avoid its  complications

The operations are

Open removal of gall bladder (cholecystectomy) interval cholecystecomy done after the adhesion and all inflammatory oedema  of the gall bladder are subside usually after 3 week done by right subcostal kocher incision or rare paramedian incision

Laparoscopic cholecystectomy become widely used nowadays

Cholesystostomy an opening is made in the gall bladder to drainage bile this may be the only possible procedure to done if there is massive adhesion around the gall bladder and the anatomy  is not clear so it is safe to done it to avoid complications of injury of common bile duct or colon or other near structures or very poor general condition of the patient whom can not standing cholecystectomy

What are the differential diagnosis of acute cholecystits

• High retrocecal acute appendicitis
• Right acute pyelitis
• Right pyonephtosis
• Acute intestinal obstruction
• Amoebic liver abscess

Acute non calcular cholecystitis see here
See more http://healthhomeup.com/chronic-cholecystitis-causes-diagnosis-treatment/ 

You can see also

• Gallbladder anatomy
• Biliary duct anatomy including the common bile duct common hepatic duct and its branches and cystic duct anatomy
• Diagnosis or investigations of biliary channels
• Gallbladder function
• Gallbladder stones causes types diagnosis and treatment
• Acute cholecystitis causes types diagnosis and treatment
• Chronic cholecystitis causes types diagnosis and treatment
• Acaclular or non calcular cholecystitis causes diagnosis and treatment
• Ascending cholangitis causes diagnosis and treatment
• Sclerosing cholangitis  types causes diagnosis and treatment
•    Gallbladder cancer causes diagnosis and treatment
• Bile duct cancer or cholangiocarcinoma causes diagnosis and treatment
• Bile duct cysts or choledochal cysts causes types diagnosis and treatment
• Bile ducts injury or strictures causes types diagnosis and treatment
• Problems after gall bladder removal or postcholecystectomy complications

tags:cholecystitis,causes,acute,treatment