ACUTE CHOLECYSTITIS- RUQ ABDOMINAL PAIN
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• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Acute Cholecystitis
• It is one of the common surgical problems you see in surgical wards.
• I have discussed the various causes for RUQ pain, etiology, pathology, clinical features, investigations, complications and treatment of Acute Cholecystitis.
• I have also included a mind map, a diagnostic and a treatment algorithm for Acute Appendicitis.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
4. ACUTE CHOLECYSTITIS
-Epidemiology
Cholecystitis is inflammation of the
gallbladder most commonly due to an
obstruction of the cystic duct by gallstones
arising from the gallbladder (cholelithiasis).
Uncomplicated cholecystitis has an excellent
prognosis; the development of complications
such as perforation or gangrene renders a bad
prognosis.
10%-20% of Americans have gallstones, and as
many as one third of these people develop
acute cholecystitis
AGE: The incidence of cholecystitis increases
with age. Explanation for this is unclear.
Sex distribution: Gallstones are 2-3 times
more frequent in females than in males,
resulting in a higher incidence of calculous
cholecystitis in females. Elevated progesterone
levels during pregnancy is the cause.
Acalculous cholecystitis is observed more often
in elderly men.
Prevalence by race and ethinicity: More
common in people of Scandinavian descent,
Pima Indians, and Hispanic populations. In
the United States, white people have a higher
prevalence than black people.
5. ACUTE CHOLECYSTITIS
-ETIOLOGY
Risk factors for Calculus Cholecystitis: 90%
- Female
- Fat- obese
- Fertile- Multigravida
- Forty- elderly
- Certain ethnic groups
- Certain drugs like HRT in females
Risk factors for Acalculus Cholecystitis:
10%
- Critically ill patients
- Those who underwent major
surgery/trauma/Burns
- Severe Sepsis
- Prolonged fasting
- Long term TPN
- Sickle cell disease
- Immunocompromised patients- Diabetes & HIV
Admirand Triangle
Percentages of saturation
of three elements in bile
lead to precipitation and
cholesterol stone formation
These three elements are
cholesterol, lecithin and
bile salts.
The normal ratio between
cholesterol and lecithin &
bille salt is 1: 30
If this ratio comes below
1: 13 the cholesterol gets
precipitated and crystals
form.
6. ACUTE CHOLECYSTITIS
-PATHOLOGY
90% of cases of cholecystitis involve
calculous cholecystitis, with the other
10% of cases representing acalculous
cholecystitis.
Acute calculous cholecystitis is caused
by an obstruction of the cystic duct,
leading to distention of the gallbladder.
As the gallbladder becomes distended,
blood flow and lymphatic drainage are
compromised, leading to mucosal
ischemia and necrosis.
Acalculous cholecystitis- exact
mechanism is unclear. Injury may be
the result of retained concentrated bile.
Stage 1: stone lodges in cystic
duct; midepigastric colickypain
Stage 2: stone impacts in cystic
duct; pain shift to RUQ;
radiation to right
scapula/shoulder
Stage 3: bacterial invasion GB
wall; + Murphy sign; subsides if
stone falls out
Stage 4: perforation
9. ACUTE CHOLECYSTITIS
- INVESTIGATIONS
1. In Acalculus
Cholecystitis and
equivocal USG
2. Normal GB- will
take-up tracer
3. In Ac cholecystitis-
Tracer not taken
up by GB
13. ACUTE CHOLECYSTITIS
- TREATMENT
Most consider that it is safe to observe patients with
asymptomatic gallstones, with cholecystectomy
reserved for patients who develop symptoms or
complications
If patients come within 3 days of onset of
symptoms Immediate Cholecystectomy
If patients are going to come after 3 days of onset of
symptoms do conservative treatment to cool down
the inflammation first and do elective
Cholecystectomy after 45 days
If severe Cholecystitis with comorbidities Do
percutaneous cholecystostomy. However, an interval
cholecystectomy will be required once the patient’s
condition has stablised.