Cholecystitis

Dr.bonifacius lukmanto spb

Introduction
Cholecystitis : inflammation of the gallbladder

Most commonly obstruction of the cystic duct by gallstone

Small part acalculous cholecystitis
Classification
Acute cholecystitis

begins suddenly

severe and steady pain in the upper abdomen lasts more than 6
hours

95% have gallstone ( inflammation may cause the gallbladder to fill

with fluid )

rarely without gallstone

Gallbladder may contain sludge

More serious

Tends to occur after : major surgery, critical illness, sepsis, iv

feeding or fasting a long time, deficiency immune system

Can occur in young children : developing from viral or another

infection

Chronic cholecystitis

lasts a long time

results from gallstone or prior attacks of acute cholecystitis

repeat attacks of pain ( biliary colic )

may become thick walled, scarred and small gallbladder

usually also contains sludge

calcium maybe deposited in the walls ( porcelain gallbladder )

Symptoms and signs
Acute cholecystitis

pain in the upper right abdomen and worsen when breathing deeply

referred pain to the right scapula

nausea and vomiting

fever and chills

right abdominal muscle stiffness

murphy sign

boas sign ( hyperesthesia of skin over right ribs 9-11 posteriorly)

mass

older people maybe have vague symptoms : lose appetite, feel

tired, weak, vomit

persistence of the acute episode

serious complication :
abscesses formation or perforation

acalculous cholecystitis tends to be very ill : lead to gangrene or

rupture gallbladder
Chronic cholecystitis

have recurring attacks of pain

tender to touch in the upper right abdomen

rarely fever

less severe pain and shortly

Diagnosis
Based on symptoms and imaging tests
USG
* the best way to detect gallstones
*Detect fluid around gallbladder or thickening the wall
Ct scan
* detect some complication (pancreatitis, perforated gallbladder )
Blood tests
* wbc, liver function
Treatment
Hospitalized
Not allow to eat or drink
Given fluids and electrolytes iv
Ngt to keep stomach empty
Antibiotics iv
Acute cholecystitis
remove the gallbladder within 24-48 hours after symptom, if :

Risk of surgery is small

Older people or diabetes

Abscess, gangrene or perforated is suspected

Acalculous cholecystitis
if the attack subsides : delayed for 6 weeks or more
if too risky surgery ( heart, lung, kidney disorder ) : delayed until
appropriate treatment
Chronic cholecystitis
removed after the current attack subsides
Cholecystectomy is done by laparoscopic or open
Laparoscopic is gold standard for cholecystectomy