ACUTE CHOLECYSTITIS

ACUTE CHOLECYSTITIS


                                                                ACUTE CHOLECYSTITIS

  • Acute cholecystitis is the inflammation of gall bladder usually gallstone obstructs the cystic duct.
  • Occurs in patients with pre- existing chronic cholecystitis usually.

 

RISK FACTORS-

  • E. Coli (MC)
  • Klebsiella
  • S. Faecalis

 

CLINICAL FEATURES-

  • Right upper quadrant pain with tenderness, guarding and rigidity.
  • Triad- fever, leucocystitis and minimum duration 24 hours
  • Murphy’s sign/ Naunyn’s sign- right upper quadrant tenderness that is exacerbated during inspiration by the examiner’s right coastal palpation.
  • Boas’s sign- area of hyperesthesia between 9th and 11th ribs posteriorly on the right side (hyperesthesia at inferior angle of right scapula).

 

INVESTIGATIONS-

  • USG- IOC (>4cm)
  • Biliary radionuclide scan- no filling after 4 hours indicated obstructed cystic duct.
  • HIDA/ PIPIDA scan- gold standard investigation

 

TREATMENT-

  • Within 72 hours attack- management followed hospitalization followed by cholecystectomy.
  • After 3- 6weeks elective Cholecystectomy.

Exam Important

  • Acute cholecystitis is the inflammation of gall bladder usually gallstone obstructs the cystic duct.
  • Occurs in patients with pre- existing chronic cholecystitis usually.
CLINICAL FEATURES-

  • Right upper quadrant pain with tenderness, guarding and rigidity.
  • Triad- fever, leucocystitis and minimum duration 24 hours
  • Murphy’s sign/ Naunyn’s sign- right upper quadrant tenderness that is exacerbated during inspiration by the examiner’s right coastal palpation.
  • Boas’s sign- area of hyperesthesia between 9th and 11th ribs posteriorly on the right side (hyperesthesia at inferior angle of right scapula).
INVESTIGATIONS-

  • USG- IOC (>4cm)
  • Biliary radionuclide scan- no filling after 4 hours indicated obstructed cystic duct.
  • HIDA/ PIPIDA scan- gold standard investigation
TREATMENT-

  • Within 72 hours attack- management followed hospitalization followed by cholecystectomy.
  • After 3- 6weeks elective Cholecystectomy.
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