This is Basically for Medical Student

1. ACUTE CHOLECYSTITIS
LT COL SM SHAHADAT HOSSAIN
MCPS,FCPS( Surgery),FCPS(Thoracic Surgery)
Adv Trg on Thoracoscopy,CNUH,South Korea

2. ACUTE CHOLECYSTITIS
 Commonly, it occurs in a patient with pre-
existing chronic cholecystitis but often also can
occur as a first presentation.
 Usual cause is impacted gallstone in the
Hartmann’s pouch, obstructing cystic duct.

3. Causative bacteria
 E. coli—most common
 Klebsiella, Pseudomonas, Proteus
 Strep. faecalis
 Salmonella
 Clostridium welchii

4. Classification
1. Acute calculous cholecystitis.
2. Acute acalculous cholecystitis (10%).

5. Mode of Infection
 Haematogenous through hepatic artery—cystic
artery.
 Portal vein.
 Through bile.

6. Pathology of Acute Cholecystitis
 Gallbladder distended with oedematous friable
wall.
 Wall contains dilated vessels.
 Areas of necrosis and patchy gangrene may
occur in severe cases.
 Mucosa shows ulceration and necrosis.
 Lumen contains infected fluid/infected bile or
frank pus.

7. Clinical Features
 Sudden onset of pain in the right
hypochondrium, with tenderness, guarding, and
rigidity.
 Fever, nausea (25%).
 Jaundice.
 Tachycardia.
 Palpable, tender, smooth, soft gallbladder.
 Area of hyperaesthesia between 9th and 11th
ribs right posteriorly (Boas’s sign).
 Murphy’s sign: positive.

8. Investigations
 Total blood count: neutrophilia.
 LFT increased serum bilirubin.
 Ultrasound abdomen—reveals presence or
absence of gallstones; and thickening of
gallbladder wall.
 Plain X-ray abdomen—10% of gallstones are
radio-opaque.
 HIDA radioisotope study; Non-visualisation of
gallbladder.
 CT scan to identify perforation, impacted stone,
wall thickness and oedema.

9. Differential diagnosis of radio-opaque
shadow
1. Kidney stone
2. Gallstone
3. Calcified 12th rib tip
4. Phlebolith
5. Pancreatic stone
6. Radio-opaque foreign body
7. Faecolith
8. Calcified lymph node
9. Calcified renal tuberculosis
10. Adrenal tumour—calcification

10. Ultrasound

11. Complications of Acute Cholecystitis
 Perforation.
 Peritonitis.
 Empyema gallbladder.
 Cholecystoduodenal, cholecystobiliary fistula,
mirrrizi's syndrome.
 Pericholecystitic abscess.
 Cholangitis and septicaemia.

12. Differential diagnosis
 Duodenal ulcer perforation
 Acute pancreatitis
 Acute appendicitis
 Acute pyelonephritis
 Lobar pneumonia,
 Myocardial infarction

13. Treatment
Conservative treatment (95%):
i. NPO-Nil per mouth.
ii. IV fluids.
iii. Analgesics and antispasmodics.
iv. Broad spectrum antibiotics (i.e.cefuroxime,
ceftriaxone, metronidazole).
After 6 weeks elective cholecystectomy.

14. EMPYEMA GALLBLADDER
 It is a type of acute cholecystitis wherein the
gallbladder is filled with pus.
 When mucocele of the gallbladder gets
infected.

15. Treatment
 Antibiotics: cefotaxime, quinolones,
ceftriaxone.
 Cholecystectomy—an emergency procedure.
 Cholecystostomy with foley’s or malecot’s
catheter kept in situ.
 After 6 weeks, cholecystectomy is done.

16. MUCOCELE OF THE GALLBLADDER
 It is due to obstruction of the cystic
duct by a stone in the neck
(Hartmann’s pouch) of the gallbladder,
without infection or inflammation.
 This causes absorption of all bile and
secretion of mucous allowing
gallbladder to distend causing
mucocele of the gallbladder.
 Content is usually sterile.

17. Features:
 Painless swelling in the right
hypochondrium.
 Non-tender, smooth, soft, globular,
palpable gallbladder.
Treatment:
 Cholecystectomy