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ACUTE CHOLECYSTITIS Dr Mayank


DEFINITION Inflammation of gall bladder is called ACUTE CHOLECYSTITIS.


INCIDENCE 

COMMON IN FERTILE

FATTY

ABOVE FORTY

FEMALES


AETIOLOGY 1 

2    

CALCULOUS Obstruct cystic duct ACALCULOUS Cholesterolosis(strawberry gall bladder) Cholesterol polyposis of gall bladder Cholecystitis glandularis proliferans Diverticulosis of gall bladder Typhoid of gall bladder


    

BACTERIAL INFECTION E-coli Klebsiella S.faecalis Salmonella Clostridia Anaerobes


     

SEVERE ILLNESS

Ileus Sepsis Severe burns/injuries Starvation Multiple blood transfusions

CARCINOMA


PATHOLOGY   • • •       

INFLAMMATION LOCALIZATION Ileus Movement of omentum Loops of intestine RESOLUTION EMPYEMA MUCOCELE PERFORATION GENERALIZED PERITONITIS LOCAL ABSCESS FISTULA


CLINICAL FEATURES PAIN

 SITE - RIGHT HYPOCHONDRIUM  TYPE - COLICKY  ONSET – SUDDEN

 DURATION – MORE THAN 12 hrs     

RADIATION

BACK SHOULDER RIGHT HYPOCHONDRIUM LEFT HYPOCHONDRIUM


 PRECIPITATING

FACTORS

Fatty Food  Movement  Breathing  RELIEVING FACTORS  Analgesics 

 FEVER

 NAUSEA/VOMITING

 DISTENTION/CONSTIPATION  JAUNDICE


SIGNS  GENERAL  

TACHYCARDIA PYREXIA

 LOCAL     

TENDERNESS - RT HYPOCHONDRIUM RIGIDITY - RT HYPOCHONDRIUM MURPHY’S SIGN BOAS SIGN MASS


INVESTIGATIONS      

BLOOD COMPLETE PICTURE LEUCOCYTOSIS URINE BILIRUBIN PLAIN X-RAY ABDOMEN Radioopaque gall stones

 ULTRASONOGRAPHY   

Dilatation of billiary tree Stones Fluid


GALL BLADDER RADIONUCLIDE SCAN

ORAL CHOLECYSTOGRAM

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)


ABDOMINAL ULTRASOUND SHOWING GALL STONES


CHOLECYSTOGRAM


DIFFERENTIAL DIAGNOSIS          

COMMON ACUTE PANCREATITIS PERFORATED DUODENAL ULCER PERFORATED PEPTIC ULCER APPENDICITIS RARE ACUTE PYELONEPHRITIS HEPATITIS MYOCARDIAL INFARCTION PNEUMONITIS


COMPLICATIONS         

EMPYEMA PERFORATION PERITONITIS ABSCESS FISTULA MUCOCELE ACUTE PANCREATITIS GALL STONE ILEUS OBSTRUCTIVE JAUNDICE


Acute Cholecystitis