CHOLECYSTITIS
MBBS
CMS DEPT OF SURGERY
GOMBE STATE UNIVERSITY
FORMAT
• INTRODUCTION
• ANATOMY/PHYSIOLOGY
• PATHOLOGY
• CLINICAL FEATURES
• INVESTIGATION
• TREATMENT
• PROGNOSIS/FOLLOWUP
• CONCLUSION
INTRODUCTION
• DEFINITION-CHOLECYSTITIS IS THE INFLAMMATION OF GALL
BLADDER,CHOLANGITIS-BILIARY TREE INFLAMMATION.
• IMPORTANCE-SEVERAL DIFFERENTIALS,SEVERAL AETIOLOGICAL
FACTORS.
• EPIDEMIOLOGY-OBSTRUCTIVE-90%,INFECTIVE-8-10%
ANATOMY/PHYSIOLOGY
• EMBRYOLOGICAL ABBERATIONS
• INTRA/EXTRA HEPATIC BILIARY TREE
• GALL BLADDER
• BILE VOLUME AND CONSTITUENTS
• GALL BLADDER CONTRACTIONS/CLINICAL CORRELATES
PATHOLOGY
• OBSTRUCTION
• INFECTION
• MIRRIZI SYNDROME
CLINICAL FEATURES
• HISTORY-RIGHT HYPOCHONDRIAL/EPIGASTRIC PAIN,GRADUAL IN
NON OBSTRUCTIVE BUT SUDDEN IN OBSTRUCTIVE.
• NAUSEA AND VOMITING OCCUR IN EARLY STAGES ,MAY BE SEVERE.
• PYREXIA > or =38oc,RIGOR MAY OCCUR IN FULMINANT CASES.
• JAUNDICE IS TRANSIENT DAY 2ND/3RD.
CLINICAL FEATURE CONT
• EXAMINATION-TENDERNESS,REBOUND TENDERNESS,GUARDING OR
RIGIDITY IN THE RT HYPOCHONDRIUM/EPIGASTRIUM
• WITH SUBSIDING CONDITION,MASS FELT IN RT HYPOCHONDRIUM
FORMED BY GALL BLADDER AND OMENTUM COLLECTIVELY REFERED
TO AS OMENTAL PHLEGMON HOWEVER IN ELDERLY IT MAY BE
EMPYEMA OR CARCINOMA.
• MURPHYS SIGN +VE
• BOAS SIGN +VE[TENDERNESS 9-11TH RIBS POSTERIORLY]
• MUCOCELE IS THE STRONG DIFFERENTIAL IN ABSENCE OF PYREXIA.
DIFFERENTIAL DIAGNOSIS
• ACUTE APPENDICITIS
• ACUTE PYELONEPHRITIS
• HEPATITIS
• ACUTE EXERCABATION OF PUD
• MYOCARDIAL INFARCTION
• PNEUMONIA
• DIAPHRAGMATIC PLEURISY
INVESTIGATIONS/DIAGNOSTIC AIDS
• FULL BLOOD COUNT-LEUCOCYTOSIS
• LIVER FUNCTION TEST-RAISED ALKALINE
PHOSPHATASE/TRANSAMINASES
• BILIRUBIN/SERUM AMYLASE
• PLAIN XRAY-CALCULUS/GAS IN GALL BLADDER-[CLOST
WELCHI,STREPTOCOCCI,ANAEROBES AND FROM STONE PASSED TO
THE DUODENUM]
INVESTIGATIONS/DIAGNOSTIC AIDS CONT
• ULTRASONOGRAPHY-ACOUSTIC SHADOW OF CALCULUS,THICKENING
OF GALL BLADDER WALL WITH SEROSAL OEDEMA[HALO SIGN].
• MUCH THICKER WALL OF GALL BLADDER IN CHRONIC CHOLECYSTITIS
BECAUSE OF REPEATED EPISODES FROM ACUTE.
TREATMENT[NON OPERATIVE]
A-REST OF THE INFLAMMED GALL BLADDER-NIL PER OS[NPO]
-NASOGASTRIC ASPIRATION
-REPLACEMENT OF FLUID/ELECTROLYTE
-ANTICHOLINERGICS-TO REDUCE GASTRIC/PANCREATIC SECRETIONS
TREATMENT[NON OPERATIVE]CONT
B-SEDATION-PETHIDINE I.M 100MG, IBUPROFEN
C-ANTIBIOTICS 3RD GENERATION CEPHALOSPORINS,GENTAMICIN
CONTRAINDICATIONS TO NON
OPERATIVEMEASURES
• PERSISTENT RAISE TEMP,PULSE
• SPREADING GANGRENE-HYPERAEMIA ON SKIN
• PRESENCE OF INFLAMMATORY MASS IN RT HYPOCHONDRIUM
• MUCOCELE
• DETECTION OF GAS IN EXTRABILIARY SYSTEM
• INTESTINAL OBSTRUCTION
OPERATIVE TREATMENT
• EARLY-WITHIN 24-72HRS OR NEXT AVAILABLE OPERATION LIST
• DELAYED-6-8WEEKS AFTER CONSERVATIVE MEASURES
• FOR CHRONIC CHOLECYSTITIS-USUALLY PLANNED;
OPERATIVE/CHEMOTHERAPY, HOWEVER IT CAN BE URGENT BECAUSE
OF THE THREAT THEY CAN CAUSE TO THE COMMUNITY ESP DUE TO
SALMONELLA TYPHI.
PROGNOSIS
• MORTALITY IS 2-3% HOWEVER THIS CAN BE HIGHER IN PATIENTS
ABOVE 70YRS DUE TO NUMEROUS PREMORBID CONDITIONS
ESPECIALLY CARDIOPULMONARY.
CONCLUSION
• DETAILED HISTORY WITH THE ATTENDAND DIFFERENTIALS,GOOD
CLINICAL ACUMEN WITH DIAGNOSTIC AIDS CAN FURTHER REDUCE
MORTALITY FROM UNNECESSARY DELAY ESPECIALLY IN THE 3RD
WORLD.
•THANK YOU