L12: Cholecystitis Flashcards by Ahmed Farag

Q

Def of Cholecystitis

A

Acute bacterial inflammation of the gall bladder with or without stone

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Q

Types of Cholecystitis

Def of Acute Cholecystitis

A

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Q

Majority of calculous acute cholecystitis are due to organisms such as ……

A

E. coli
Salmonella
Streptococci
Klebsiella, etc.

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Q

Typhoid & acute Cholecystits

A

Typhoid fever: can also cause Typhoid Cholecystitis around 2nd week of infection.

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Q

Clostrium & acute Cholecystitis

A

Clostridial infection of the gall bladder produces acute cholecystitis with toxemia.

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Q

Pathogenesis of Acute Cholecystitis

A

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Q

Type of Patient in Acute Cholecystitis

A

fatty, fertile, female

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Q

Acute Cholecystitis in a young boy?

A

You may be surprised to find a young boy, a girl or even a child with gall stones suspect hemolytic anemias.

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Q

CP of Acute Cholecystitis

A

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Q

Signs in Acute Cholecystitis

A

Murphy Sign
Boas’ Sign
Vague Mass
Upper abdominal guarding, rigidity

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Q

Importance of Murphy sign

A

Is a diagnostic sign of acute cholecystitis

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Q

Technique of Murphy sign

A

1) Keep the fingers in the right hypochondrium.

2) Ask the patient to take a deep inspiration.

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Q

Result of Murphy sign

A

+ve murphy’s sign

At the height of inspiration there is a sudden catch in the inspiration.

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Q

Explanation of Murphy sign

A

It is due to inflamed gall bladder coming in contact with the abdominal wall under the fingers & producing pain.

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Q

Boas’ Sign

A

An area of hyperaesthesia between 9” and 11” ribs posteriorly on the Rt Side

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Q

Vague mass in Acute Cholecystitis is consisting of ……

A

Inflamed gall bladder
Omentum
Inflammatory exudate

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Q

Vague Mass of acute cholecystits

Surgical Importance

A

Even if a perforation occurs, generalized peritonitis is uncommon.

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Q

DDx of Acute Cholecystitis

A

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Q

DDx of Acute Cholecystitis

Perforated PU

A

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Q

DDx of Acute Cholecystitis

Acute Pancreatitis

A

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Q

DDx of Acute Cholecystitis

High Rectocecal Appendicitis

A

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Q

DDx of Acute Cholecystitis

Amoebic Liver Abcess

A

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Q

DDx of Acute Cholecystitis

Lobar Pneumonia (Basal)

A

Can cause right hypochondriac guarding and rigidity.
It is a referred pain.

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Q

Investigations for Acute Cholecystitis

A

Lab
Rad

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Lab investigations of **Acute Cholecystitis**

- CBC - Sugar Estimation

CBC in **Acute Cholecystitis**

Total WBC count is always raised

Sugar Estimation in **Acute Cholecystitis**

- Blood and urine - To rule out diabetes mellitus

Imaging in **Acute Cholecystitis**

- X-ray - US - HIDA - CT

X-Ray in **Acute Cholecystitis**

DDx of Radio-Opaque Shadow in X-Ray

Uses of US in **Acute Cholecystitis**

**Emergency ultrasonography:** - In calculous cholecystitis: (Success rate is >95%) - Acalculous cholecystitis - Demonstration of Murphy’s sign - Measure gall bladder function - It can detect gall bladder polyps.

US in calculous cholecystitis

To demonstrate stones, which cast posterior acoustic shadow.

US in Acalculous cholecystitis

|t can demonstrate inflamed, thickened organ.

Demonstration of Murphy's Sign in Acute cholecystitis

with the help of ultrasonography is possible which adds to the diagnosis.

Measure gall bladder function by US

By using ultrasonic dimensions of the gall bladder.

Importance of HIDA

1. Diagnosis of acalculous cholecystitis . 2. The diagnosis is i ndoubt

Method of HIDA

1. IV administration of 99mTc labeled HIDA agent 2. Then it is excreted in the biliary tree within one hour

Findings in HIDA

non-visualization of the gall bladder is diagnostic of acute cholecystitis.

..

Explanation of HIDA

- The dye is excreted in the biliary tree & does not enter the gall bladder due to edema of the cystic duct.

Indications of CT in **Acute Cholecystitis**

When ultrasound findings are not clear

importance of CT in **Acute Cholecystitis**

Findings of CT in **Acute Cholecystitis**

TTT of **Acute Cholecystitis**

- Conservative - Surgical

Conservative TTT of **Acute Cholecystitis**

Types of Cholecystectomy in **Acute Cholecystitis**

- Early - Emergency - Prophylactic

Def of Early Cholecystectomy in **Acute Cholecystitis**

cholecystectomy from the 2 day to the 7 day

Disadvantages of Early Cholecystectomy

Advantages of Early Cholecystectomy

Surgery can be done safely if

Incidence of **Emergency Cholecystectomy**

About 10% of cases of acute cholecystitis require emergency cholecystostomy.

Deciding Factors in **Emergency Cholecystectomy**

Other Indications of **Emergency Cholecystectomy**

1. Acalculous cholecystitis. 2. Perforated gall bladder with peritonitis.

Def of **Prophylactic Cholecystectomy**

Cholecystectomy for asymptomatic gall bladder stones.

Indications of **Prophylactic Cholecystectomy**

1. Diabetic patients. 2. Congenital hemolytic anemia. 3. Patients undergoing bariatric surgery.

Prognosis of **Acute Cholecystitis**

Contriburing Factors to Death in **Acute Cholecystitis**

1. Diabetes. 2. age above 60 years. 3. cardiovascular or pulmonary disease.

Def of ****Chronic Cholecystitis****

Recurrent attacks of cholecystitis will convert the gall bladder into a fibrosed, nonfunctioning, contracted, shrunken, small gall bladder

Pathology of ****Chronic Cholecystitis****

CP of **Chronic Cholecystitis**

Present with classical fatty food intolerance

Dx of **Chronic Cholecystitis**

TTT of **Chronic Cholecystitis**

Cholecystectomy

Def of **Mucoscele**

A stone blocking the cystic duct and the bile is not infected.

Pathophysiology of **Mucoscele**

CP of ****Mucoscele****

TTT of ****Mucoscele****

Cholecystectomy

Incidence of ****Empyema & Perforation of GB****

Uncommon

PPT Factors For ****Empyema & Perforation of GB****

CP of **Empyema & Perforation of GB**

Patients present with 1. High-grade fever with chills and rigors 2. Toxicity 3. High leukocyte count.

Types of **Empyema & Perforation of GB**

Localized perforation with pericholecystic abscess

Free perforation into the general peritoneal cavity

Done

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