FN: Acute and Chronic Cholecysitis Flashcards Preview

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Flashcards in FN: Acute and Chronic Cholecysitis Deck (21):
1

Pathogeneisis

Stone or sludge impaction in HArtmanns pouch
-- chemical and/or bacterial inflammation
5% are acalculous: sepsis, burns, DM

2

Sequelae

1. resolution ± recurrence
2. Gangrene and rarely perforation
3. Chronic cholecystitis
4. Empyema

3

Presentation

Severe RUQ pain
-continuous
-Radiates to right scapula and epigastrium

Fever
Vomiting

4

Examination

1. Local peritonism in RUQ
2. Tachycardia w/ shadow breathing
±jaundice
Murphys sign
Phlegmon
Boas sign

5

Murphys signs

2 fingers over the GB and ask pt. to breath in

Pain and breath catch, Must be -ve on the left hand side

6

Phlegmon

May be palpable - mass of adherent omentum and bowel

7

Boas sign

Hyperaesthesia below the right scapula

8

Investigation

Urine
Bloods
Imaging

9

Urine shows

Bilirubin, urobilinogen

10

Bloods

FBC: raised WCC
U+E: dehydration form vomiting
Amylase, LFTs, G+S, clotting, CRP

11

Imaging

AXR: gallstone, percelain, gallbladder
Erect CXR: look for perforation
Us:
1. Stones: acoustic shadow
2. Dilated ducts (>6mm)
Inflamed GB: wall oedema

12

MRCP

If dilated ducts seen on

13

Management Conservative

NBM
Fluid resuscitation
ANalgesiaL paracetaol, diclofenac, codeine
Abx: cefuroxime and metronidazole
80-90% settle over 24-48h
Detertioration: perforation . empyem

14

Surgical

May be elective surgery @ 6-12 wks (reduced inflammation)
If

15

Empyema management

High fever
RUQ mass
Percutaneous drainage: cholecystostomy

16

Chronic Cholecustitis symptoms

Flatulent Dyspepsia
1. Vague upper abdominal discomfort
Distension, bloating
Nausea
Flatulena, burping
Symptoms exacerbated by fatty foods - CCK release stimulated gallbaldder

17

Differential

PUD
IBS
Hiatus HErnia
Chronic pancreatitis

18

Investigation

AXRL porcelain gallbladder
US: stones, fibrotic, shrunken gallbladder
MRCP

19

Management medical

Bile salts (not very effective)

20

Surgica lmamagement

Elective cholecystectomy
ERCP first if US shows dilated ducts and stones

21

Rare gallstone disease

Mucocela
Gallbladder
Mirizzis syndrome
Gallstone ileus

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