ACUTE ACUTE CHOLECYSTITISCHOLECYSTITIS

Dr MayankDr Mayank

DEFINITIONDEFINITION

Inflammation of gall bladder is Inflammation of gall bladder is called ACUTE CHOLECYSTITIS.called ACUTE CHOLECYSTITIS.

INCIDENCEINCIDENCE COMMON IN FERTILECOMMON IN FERTILE

FATTYFATTY

ABOVE FORTYABOVE FORTY

FEMALESFEMALES

AETIOLOGYAETIOLOGY1 CALCULOUSCALCULOUS Obstruct Obstruct cysticcystic duct duct

2 ACALCULOUSACALCULOUS Cholesterolosis(strawberry gall bladderCholesterolosis(strawberry gall bladder)) Cholesterol polyposis of gall bladderCholesterol polyposis of gall bladder Cholecystitis glandularis proliferansCholecystitis glandularis proliferans DiverticuDiverticulosis of gall bladderlosis of gall bladder Typhoid of gall bladderTyphoid of gall bladder

BACTERIAL INFECTIONBACTERIAL INFECTION E-coliE-coli KlebsiellaKlebsiella S.faecalisS.faecalis SalmonellaSalmonella Clostridia AnaerobesClostridia Anaerobes

SEVERE ILLNESSSEVERE ILLNESS IleusIleus SepsisSepsis Severe burns/injuriesSevere burns/injuries StarvationStarvation Multiple blood transfusionsMultiple blood transfusions

CARCINOMACARCINOMA

PATHOLOGYPATHOLOGY INFLAMMATIONINFLAMMATION LOCALIZATIONLOCALIZATION• IleusIleus• Movement of omentumMovement of omentum• Loops of intestineLoops of intestine RESOLUTIONRESOLUTION EMPYEMAEMPYEMA MUCOCELEMUCOCELE PERFORATIONPERFORATION GENERALIZED PERITONITISGENERALIZED PERITONITIS LOCAL ABSCESSLOCAL ABSCESS FISTULAFISTULA

CLINICAL FEATURESCLINICAL FEATURES PAINPAIN SITESITE - RIGHT HYPOCHONDRIUM - RIGHT HYPOCHONDRIUM TYPE TYPE -- COLICKY COLICKY ONSETONSET – SUDDEN – SUDDEN DURATIONDURATION – MORE THAN 12 hrs – MORE THAN 12 hrs RADIATIONRADIATION BACKBACK SHOULDERSHOULDER RIGHT HYPOCHONDRIUMRIGHT HYPOCHONDRIUM LEFT HYPOCHONDRIUMLEFT HYPOCHONDRIUM

PRECIPITATING FACTORSPRECIPITATING FACTORS Fatty FoodFatty Food MovementMovement Breathing Breathing RELIEVING FACTORSRELIEVING FACTORS AnalgesicsAnalgesics

FEVERFEVER NAUSEA/VOMITINGNAUSEA/VOMITING DISTENTION/CONSTIPATIONDISTENTION/CONSTIPATION JAUNDICEJAUNDICE

SIGNSSIGNS GENERALGENERAL TACHYCARDIATACHYCARDIA PYREXIAPYREXIA LOCALLOCAL TENDERNESS - RT HYPOCHONDRIUMTENDERNESS - RT HYPOCHONDRIUM RIGIDITY - RT HYPOCHONDRIUMRIGIDITY - RT HYPOCHONDRIUM MURPHY’S SIGNMURPHY’S SIGN BOAS SIGNBOAS SIGN MASSMASS

INVESTIGATIONSINVESTIGATIONS BLOOD COMPLETE PICTUREBLOOD COMPLETE PICTURE LEUCOCYTOSISLEUCOCYTOSIS URINEURINE BILIRUBINBILIRUBIN PLAIN X-RAY ABDOMENPLAIN X-RAY ABDOMEN Radioopaque gall stonesRadioopaque gall stones ULTRASONOGRAPHYULTRASONOGRAPHY Dilatation of billiary treeDilatation of billiary tree StonesStones FluidFluid

GALL BLADDER RADIONUCLIDE SCAN GALL BLADDER RADIONUCLIDE SCAN

ORAL CHOLECYSTOGRAMORAL CHOLECYSTOGRAM

PERCUTANEOUS TRANSHEPATIC PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)CHOLANGIOGRAPHY (PTC)

ENDOSCOPIC RETROGRADE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)CHOLANGIOPANCREATOGRAPHY (ERCP)

MAGNETIC RESONANCE MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)CHOLANGIOPANCREATOGRAPHY (MRCP)

ABDOMINAL ULTRASOUND SHOWING GALL ABDOMINAL ULTRASOUND SHOWING GALL STONESSTONES

CHOLECYSTOGRAM

DIFFERENTIAL DIFFERENTIAL DIAGNOSISDIAGNOSIS

COMMONCOMMON ACUTE PANCREATITIS ACUTE PANCREATITIS PERFORATED DUODENAL ULCERPERFORATED DUODENAL ULCER PERFORATED PEPTIC ULCERPERFORATED PEPTIC ULCER APPENDICITISAPPENDICITIS

RARERARE ACUTE PYELONEPHRITISACUTE PYELONEPHRITIS HEPATITISHEPATITIS MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION PNEUMONITISPNEUMONITIS

COMPLICATIONSCOMPLICATIONS EMPYEMAEMPYEMA PERFORATIONPERFORATION PERITONITISPERITONITIS ABSCESSABSCESS FISTULAFISTULA MUCOCELEMUCOCELE ACUTE PANCREATITISACUTE PANCREATITIS GALL STONE ILEUSGALL STONE ILEUS OBSTRUCTIVE JAUNDICEOBSTRUCTIVE JAUNDICE