Surgery Definition – What is acute cholecystitis?
Surgery Definition – What is acute cholecystitis?
Acute cholecystitis is known as acute inflammation of the gallbladder. The pathology of acute cholecystitis may include obstruction of the cystic duct which lead to inflammation and causing the formation of gallstone.
Patient with acute cholecystitis may present with constant right upper quadrant pain which is radiated to the epigastrium and to the right scapular tip which is known as Boas’ sign. Patient with acute cholecystitis may develop fever, nausea and vomiting. There will be history of gallstone associated with acute cholecystitis which is worsen after greasy meal in the right upper quadrant. Patient may present with jaundice, dark urine and pale stools.
On examination, patient will be ill looking with sweaty palms and tachycardia. There will be tenderness in the right upper quadrant and epigastrium with positive Murphy’s sign.
The investigation needed may include full blood count which may reveal raise in the white blood count, urea and electrolytes which may reveal disturbance in amount due to vomiting, liver function test with raise ALP in biliary tree disease, raise in bilirubin in obstructive jaundice. Amylase is considered to rule out any pancreatitis. Ultrasound is considered as a test of choice and ECG.
Patient with acute cholecystitis may be treated with admission to the ward, nil by mouth, intravenous fluid to correct the dehydration and electrolytes imbalance, broad spectrum intravenous antibiotic, opiates analgesia and and elective cholcecystectomy.
The complication of acute cholecystitis may include gallbladder perforation with bile peritonitis, empyema or abscess of the gallbladder and obstructive jaundice due to obstruction of the common bile duct due to local edema (inflamed gallbladder pressing on the nearby common bile duct or due to stone passing into the common bile duct and cholecystenteric fistula between small bowel and gallbladder and gallstone ileus.
Treatment may include cholecystectomy due to high risk of recurrent attack and to avoid any complication. Cholecystectomy is performed within 6 weeks time as local edema and distortion of the tissue planes will cause the emergency cholecystectomy more difficult technically with an increase risk of perforation of gallbladder.
Operation is only performed in acute setting due to failure of conservative treatment and the present of the complication. The complication is known as ascending cholangitis which is characterized as severe infection complicating distal common bile duct obstruction which later spread proximally.
Acute cholecystitis is known as acute inflammation of the gallbladder. The pathology of acute cholecystitis may include obstruction of the cystic duct which lead to inflammation and causing the formation of gallstone.
Patient with acute cholecystitis may present with constant right upper quadrant pain which is radiated to the epigastrium and to the right scapular tip which is known as Boas’ sign. Patient with acute cholecystitis may develop fever, nausea and vomiting. There will be history of gallstone associated with acute cholecystitis which is worsen after greasy meal in the right upper quadrant. Patient may present with jaundice, dark urine and pale stools.
On examination, patient will be ill looking with sweaty palms and tachycardia. There will be tenderness in the right upper quadrant and epigastrium with positive Murphy’s sign.
The investigation needed may include full blood count which may reveal raise in the white blood count, urea and electrolytes which may reveal disturbance in amount due to vomiting, liver function test with raise ALP in biliary tree disease, raise in bilirubin in obstructive jaundice. Amylase is considered to rule out any pancreatitis. Ultrasound is considered as a test of choice and ECG.
Patient with acute cholecystitis may be treated with admission to the ward, nil by mouth, intravenous fluid to correct the dehydration and electrolytes imbalance, broad spectrum intravenous antibiotic, opiates analgesia and and elective cholcecystectomy.
The complication of acute cholecystitis may include gallbladder perforation with bile peritonitis, empyema or abscess of the gallbladder and obstructive jaundice due to obstruction of the common bile duct due to local edema (inflamed gallbladder pressing on the nearby common bile duct or due to stone passing into the common bile duct and cholecystenteric fistula between small bowel and gallbladder and gallstone ileus.
Treatment may include cholecystectomy due to high risk of recurrent attack and to avoid any complication. Cholecystectomy is performed within 6 weeks time as local edema and distortion of the tissue planes will cause the emergency cholecystectomy more difficult technically with an increase risk of perforation of gallbladder.
Operation is only performed in acute setting due to failure of conservative treatment and the present of the complication. The complication is known as ascending cholangitis which is characterized as severe infection complicating distal common bile duct obstruction which later spread proximally.
