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Acute Cholecystitis
Discuss acute cholecystitis?
Patients with acute cholecystitis experience severe pain that persists for several hours (6hrs or more), until they finally seek help at a local emergency department. Whereas in biliary colic the cystic duct obstruction is transient, in acute cholecystitis it is persistent. Persistent cystic duct obstruction, in combination with chemical irritants in the bile, results in inflammation and edema of the gallbladder wall. Nausea and vomiting are common.
Physical examination usually reveals marked tenderness in the right upper quadrant, often associated with a definite mass or fullness. Murphy’s sign is positive. Fever and local peritoneal signs are common.
Discuss the diagnosis?
Diagnosis is suspected based on the clinical presentation above.
Blood tests reveal leukocytosis with neutrophilia. A mild elevation in bilirubin, liver enzymes and amylase occur even in the absence of cholangitis or choledocholithiasis. These abnormalities may be due to the passage of small stones, sludge, or pus.
USS- is the investigation of choice. Positive findings particularly indicative of acute cholecystitis are stones, thickening of the gallbladder wall, pericholecystic fluid, and a positive Murphy sign on contact with the ultrasonographic probe.
Cholescintigraphy (HIDA scan) - may be needed if the diagnosis remains uncertain following USS. It has no role in the diagnosis of gallstones but is very useful in excluding acute cholecystitis in patients who present with acute biliary colic. The test is positive if the gallbladder does not visualize which is invariably due to cystic duct obstruction, usually from edema associated with acute cholecystitis or an obstructing stone.
Discuss the treatment?
Discuss the complications of acute cholecystitis?
The symptoms of cholecystitis may abate spontaneously within 7 to 10 days. However, complications rates are alarmingly high with this approach; hence treatment should be started on an emergent basis. He complications of acute cholecystitis are:
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