| ID | 57 |
|---|---|
| Name | ACUTE CHOLECYSTITIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. A plain radiograph may show gall-stone (10% cases), perforation, fistula of the gall-bladder into intestine. 2. Ultrasonography- detect gall stone, thickening of gall-bladder wall and bile duct. 3. Blood count- a moderate leucocytosis. 4. Liver function tests- serum bilirubin, alkaline phosphatase & aminotransferases may be raised slightly. 5. Plasma amylase- to exclude pancreatitis |
| Management | |
| Introduction | Acute cholecystitis is defined as the acute inflammation of the gall-bladder. It is often associated with obstruction of the gall-bladder neck or cystic duct by a gall stone. The common causative organisms are- E. colir Streptococci, Staphylococci, Klebsiella, Salmonella paratyphi-B etc. Acute cholecystitis usually resolves with medical treatment, but if untreated, it may progress to an empyema & occasionally perforation & peritonitis may develop. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Symptom: 1. Pain in the right hypochondrium, but also in the epigastrium, the right shoulder tip or intercapsular region. 2. Pain is continuous & increasing in intensity; severe phase of the pain usually lasts for more than one hour & then subsides gradually over a period of 12-18 hours. 3. Pain sometimes initiated or provoked by fatty meal. 4. The patient usually develops restlessness, pallor, sweating, nausea and vomiting. 5. Pyrexia, sometimes to 38°c or more. Signs: 1. Right hypochondriac tenderness and rigidity worse on inspiration (Murphy’s sign). 2. Occasionally the gall bladder is palpable. 3. Slight jaundice may be seen. 4. Rising of temperature & rigor may occur |
| Preventions | |
| Treatment | Treatment: Treatment is initially conservative followed by surgery (cholecystectomy). A. Conservative treatment: 1. Bed rest & rest to the infalmmed gall-bladder-a. Nothing by mouth. b. Gastric aspiration for 3 to 5 days, when vomiting is severe, c. Fluid and electrolyte balance by i.v infusion. 2. Analgesics- Pethidine 100 mg i. m. and s.o.s. Morphine + Atropine may be given in severe cases. 3. Anti-spasmodics-Hyoscine butyl bromide oral or parenteral may be given to subside pain episodes. 4. Antibiotics-A cephalosporin (is the antibiotic of choice), such as cefuroxime 750mg 6 or 8 hourly i.m or i.v for 5-7 days. Plus-Metronidazole Igm 8 hourly as required. B. Surgical treatment: Where medical therapy fails to subside cholecystitis, or complication arises such as empyema or perforation, an emergency surgery can be carried out. Recently cholecystectomy (usually laparoscopic) is done after 2-3 days of medical treatment & a delayed surgery (after 2-3 months) is not advocated now a day. |
| Complications | |
| Prognosis | |
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