PATHOPHYSIOLOGY AND Department of Surgery
TREATMENT
Cholecystitis
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ACUTE
CHOLECYSTITIS
CALCULOUS
Etiology
• Most common; less serious type
• Develops when cystic duct is blocked by a
gallstone or by biliary sludge
• Results to build – up of bile in the
gallbladder
Etiology
• Less common; More serious type
• Develops as a complication of serious illness,
infection or injury
• Often associated with accidental damage to
GB during major surgery, serious injuries
ACALCULOUS
or burns, sepsis, AIDS
ABDOMINAL
Colicky; PAIN
RUQ/Epigastrium
NAUSEA &
VOMITING
FEVER
SYMPT
OMS
RIGHT INTERSCAPULAR
PAIN
Radiation from RUQ pain
ANOREXIA
Focal tenderness and guarding
Murphy’s sign
SYMPT
OMS
Pathophysiology
OBSTRUCTION at the
gallstones Hydrolysis of Luminal
Neck of the GB or
Cystic Duct Lecithin
Exposure to Disruption of Production of toxic
epithelium to direct glycoprotein mucus lyolecithin
detergent action of layer
bile salts Compromised
.
(+) GB distention & mucosal BF
(+) GB
Inc. Intraluminal
dysmotility INFLAMMATION
pressure
Diagnosti
c
procedur
es
ULTRASONOGRAPHY
- Is the most useful radiologic
test for diagnosing acute
cholecystitis.
- Presence or absence of stones
- Thickening of gallbladder
wall and pericholecystic fluid
Biliary radionuclide scan (hida
scan)
- May be help in the atypical
case.
- Lack of filling of the
gallbladder after 4 hours
indicates an obstructed duct
- Highly sensitive and specific
for acute cholecystitis
CT SCAN
- Frequently performed on
patients with acute
abdominal pain
- Demonstrates thickening of
the gallbladder wall as well as
air in the gallbladder.
Gallbladder
perforation and local
abscess
Cholangitis or sepsis COMPLICATIONS
Gallbladder rupture
Biliary enteric
(cholecytenteric)
fistula
Treatment
NON – SURGICAL
IV; Analgesic and Antibiotics
• Antibiotics – cover gram – negative aerobes and anaerobes
3rd Gen cephalosporin + Metronidazole – typical regimen
Treatment
NON – SURGICAL
Analgesic
• Ketorolac (Preferred)
• Given 30 to 60 mg single dose, IV
• Opioids such as morphine, hydromorphone or meperidine
• For patients contraindicate to NSAIDS
Treatment
NON – SURGICAL
Gallbladder drainage
• High surgical risk such as being septic or critically ill
• No appreciable clinical improvement after 1-3 days of
nonoperative management with antibiotics
• Decompresses infected bile or pus from the gallbladder
• Allows both local inflammation and systemic illness to resolve
before gallbladder removal
I W
Treatment
SURGICAL A A
Cholecystectomy
• Definitive treatment for acute cholecystitis.
Early cholecystectomy performed within 2 to 3 days
Delayed cholecystectomy performed 6 to 10 weeks after
treatment
I W
Treatment
SURGICAL A A
Laparoscopic Cholecystectomy
• Procedure of choice for acute cholecystitis.
Early cholecystectomy performed within 2 to 3 days
Delayed cholecystectomy performed 6 to 10 weeks after
treatment
I W
Treatment
LAPAROSCOPIC A A
CHOLECYSTECTOMY
• Management based on Grading
Grade I (Mild): Early laparoscopic cholecystectomy (within 72 hours)
Grade II (Moderate): Early cholecystectomy (laparoscopic or open)
Grade III (Severe): Urgent management of organ dysfunction and
gallbladder draining
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CHRONIC
CHOLECYSTITIS
Etiology
Due to repeated attacks of acute
cholecystitis
Most attacks are caused by gallstones
Common in women; > 40 y.o.
ABDOMINAL
Colicky; PAIN
RUQ/Epigastrium
NAUSEA &
VOMITING
RIGHT INTERSCAPULAR
PAIN
Radiation from RUQ pain
SYMPT
OMS
Pathophysiology
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Diagnosti
c
procedur
es
Ultrasound (Abdominal)
- Diagnostic test for gallstones
- Demonstrates thickening of
the gallbladder wall with
gallstones
I W
Treatment
SURGICAL A A
Cholecystectomy
• For symptomatic and
complicated disease
I W
Treatment
SURGICAL A A
Elective Laparoscopic Cholecystectomy
• advised in patients with symptomatic gallstones
Prevention
Lose weight slowly
Maintain a healthy weight
Choose a healthy diet
