Acute Cholecystitis

ACUTE CHOLECYSTITIS PRESENTATION BY DR YAKTA MAZHAR ROLL # 51

DEFINITION Inflammation of gall bladder is called ACUTE CHOLECYSTITIS.

IN CID EN CE 

COMMON IN FERTILE

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FATTY

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ABOVE FORTY

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FEMALES

AETIOLOGY 1 

2    



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

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    

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

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GALL BLADDER RADIONUCLIDE SCAN

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ORAL CHOLECYSTOGRAM

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PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)

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ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

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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

THANKS!