| ID | 236 |
|---|---|
| Name | ACUTE CHOLECYSTITIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: 1. Blood TC, DC: leucocytosis. 2. LFT if jaundice present. 3. Plain x-ray abdomen: radio-opaque calculi or soft tissue shadow of inflammed gall blader. 4. Ultrasonogram of HBS- most diagnostic. |
| Management | Management: General management: 1. Nothing by mouth & bed rest. 2. Fluid & electrolyte balance- D/A 2 litre, DNS 1 litre daily or as required. 3. Nasogastric suction for 3 to 5 days. 4. Anticholinergic drugs: Atropine/propantheline. Or, Hyoscine butyl bromide 2 amp i.v stat. 5. Analgesic- in severe pain morphine 10-15mg i.m & in less severe pain pethidine 100mg i.m or pentazocine 30mg i.m or diclofenac 75mg i.m or 75-150mg orally daily in divided doses; analgesic may be repeated in 2-3 hours or as required. 6. Systemic antibiotic- a cephalosporin such as cefuroxime 750mg i.m or i.v 6-hourly (or any 2nd generation or 3rd generation antibiotic) + metronidazole Igm 8-hourly by suppository or by i.v infusion in usual doses. 7. Bowel should be cleared; maintain I/O chart. 8. When the acute symptoms subsides fat free diet is advised. 9. Conservative treatment is abandoned if there is increasing pain, pulse, & temp, with spread of guarding & tenderness, then immediate laparotomy is performed. Surgical management: In acute cholecystitis, cholecystectomy is the choice of operation. There are two options for syrgical manoeuvre: 1. Early cholecystectomy (within 5-7 days of diagnosis, if it is indicated). Or, 2. Delayed (or, interval) cholecystectomy. In interval surgery, usually the patient is treated in the hospital conservatively for 10-15 days & discharged. The patient is then advised to readmit 6 weeks later for elective cholecystectomy. But, now a days early cholecystectomy has been accepted in almost cases as the mortality is not higher than for the interval surgery. Recently in many surgical units, it is prefered to do the cholecystectomy by laparoscopic method (minimal access) rather than open cholecystectomy. Indications for emergency cholecystectomy: - If the patient’s condition deteriorates - If there is generalised peritonitis - An inflammatory mass in the right hypochondrium - Gas present in the gall bladder wall or lumen - Evidence of intestinal obstruction. |
| Introduction | Acute cholecystitis: Inflammation of the gallbladder, presenting the in acute form. It is almost always associated with obstruction of the neck or cystic duct by a gallstone; occasionally, by mucus, worms or a bile tumour. |
| History | |
| Etiology | |
| Clinical Features | features: 1. Common in fertile, fair, fatty, female of fourty years. 2. Sadden agonising pain in the right upper abdomen with rigidity & tenderness. 3. Rise of temp, nausea, vomiting & tachycardia. 4. Pan increase with fatty food. 5- Boas’ sign & Murphy’s sign positive (right hypochondrium). 6. Referred pain in right scapular & shoulder region. 7. Jaundice may present. |
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