acute calculous cholecystitis

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clinical practice acute calculous cholecystitis clinical problem biliary colic develops in 1 to 4% annually, and acute cholecystitis develops in about 20% of these symptomatic patients if they are left untreated. acute cholecystitis may coexist with choledocholithiasis, cholangitis, or gallstone pancreatitis. pathogenesis obstruction of the cysticduct in the presence of bile supersaturated with cholesterol. brief impaction may cause pain only, but if impaction is prolonged over many hours, inflammation can result. with inflammation,the gallbladder becomes enlarged, tense, and reddened, and wall thickening and an exudate of peri-cholecystic fluid may develop. enterobacteriaceae family or with enterococci or anerobes : in majority of patients. the wall of the gallbladder may undergo necrosis and gangrene (gangrenous cholecystitis). bacterial super-infection with gas-forming organisms may lead to gas in the wall or lumen of the gallbladder (emphysematous cholecystitis). diagnosis the main symptom of uncomplicated cholelithiasis is biliarycolic, caused by the obstruction of the gallbladder neck …

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s cholecystitis is diagnosed radiologically by the concomitant presence of thickening of the gallbladder wall( >5 mm), peri-cholecystic fluid, or direct tenderness when the probe is pushed against the gallbladder (ultrasonographic murphy's sign). ultrasonographic images of three gallbladders. a normal, sonolucent gallbladder (panel a) is characterized by a thin wall and an absence of acoustic shadows. in a patient with symptomatic gallstones (panel b), the gallbladder contains small echogenic objects with posterior acoustic shadows that are typical of gallstones (arrow), with a normal wall thickness. in a patient with acute calculous cholecystitis (panel c), thickening is visible in the gallbladder wall (arrow), along with a large gallstone (arrowhead). imaging hepatobiliary scintigraphy involves intravenous injection oftechnetium-labeled analogues of iminodiacetic acid, which areexcreted into bile. the absence of gallbladder filling within60 minutes after the administration of tracer indicates obstructionof the cystic duct and has a sensitivity of 80 to 90% for acute …

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tment) or2 to 3 months after the initial attack has subsided (delayedtreatment). “early" has been variably definedas anywhere from 24 hours to 7 days after either the onset of symptoms or the time of diagnosis. if delayed, or "conservative,"treatment is selected, patients are treated during the acute phase with antibiotics and intravenous fluids and npo. • • • early laparoscopic cholecystectomy is considered the treatmentof choice for most patients. the rate of conversion to open cholecystectomy is higher whenlaparoscopic cholecystectomy is performed for acute cholecystitisthan for uncomplicated cholelithiasis. predictors of theneed for conversion include – wbc > 18000/mm3 duration of symptoms of more than a range of 72 to 96 hours age over 60 years antibiotic therapy the guidelinesof the infectious diseases society of america recommend that antimicrobial therapy be instituted if infection is suspectedon the basis of laboratory and clinical findings (wbc > 12500/mm3 or temperature > 38.5°c) and …

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utthat early laparoscopic cholecystectomy should be performed only by a highly experienced surgeon and promptly terminated by conversion to open cholecystostomy if operative conditionsmake anatomical identification difficult. severe acute cholecystitis: initial conservative management with antibiotics is recommended, preferably in ahigh-acuity setting, with the use of percutaneous cholecystostomyas needed; surgery is reserved for patients in whom this treatment fails. image1.jpg image2.png image3.png image4.jpg image5.jpg image6.jpg

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clinical practice acute calculous cholecystitis clinical problem biliary colic develops in 1 to 4% annually, and acute cholecystitis develops in about 20% of these symptomatic patients if they are left untreated. acute cholecystitis may coexist with choledocholithiasis, cholangitis, or gallstone pancreatitis. pathogenesis obstruction of the cysticduct in the presence of bile supersaturated with cholesterol. brief impaction may cause pain only, but if impaction is prolonged over many hours, inflammation can result. with inflammation,the gallbladder becomes enlarged, tense, and reddened, and wall thickening and an exudate of peri-cholecystic fluid may develop. enterobacteriaceae family or with enterococci or anerobes : in majority of patients. the wall of the gallbladder may undergo necrosis...

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