Cholecystitis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 17: | Line 17: | ||
* On physical examination, an inflamed gallbladder is almost always tender to the touch and palpable (~25-50% of cases) in the midclavicular right lower rib margin. Additionally, a fever is common. A gallbladder with cholecystitis is almost always tender to touch. Because of the inflammation, its size can be felt from the outside of the body in 25–50% of people with cholecystitis. Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes severe pain (Murphy's sign). Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness. | * On physical examination, an inflamed gallbladder is almost always tender to the touch and palpable (~25-50% of cases) in the midclavicular right lower rib margin. Additionally, a fever is common. A gallbladder with cholecystitis is almost always tender to touch. Because of the inflammation, its size can be felt from the outside of the body in 25–50% of people with cholecystitis. Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes severe pain (Murphy's sign). Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness. | ||
=== Complications | === Complications === | ||
A number of complications may occur from cholecystitis if not detected early or properly treated. Signs of complications include high fever, shock and jaundice. Complications include the following: | A number of complications may occur from cholecystitis if not detected early or properly treated. Signs of complications include high fever, shock and jaundice. Complications include the following: | ||
| Line 25: | Line 25: | ||
* Fistula formation and gallstone ileus | * Fistula formation and gallstone ileus | ||
* Rokitansky-Aschoff sinuses | * Rokitansky-Aschoff sinuses | ||
=== Causes === | === Causes === | ||
| Line 39: | Line 30: | ||
* Cholecystitis occurs when the gallbladder becomes inflamed. | * Cholecystitis occurs when the gallbladder becomes inflamed. | ||
* Gallstones are the most common cause of gallbladder inflammation but it can also occur due to blockage from a tumor or scarring of the bile duct. | * Gallstones are the most common cause of gallbladder inflammation but it can also occur due to blockage from a tumor or scarring of the bile duct. | ||
=== Acute calculous cholecystitis | === Acute calculous cholecystitis === | ||
Gallstones blocking the flow of bile account for 90% of cases of cholecystitis (acute calculous cholecystitis). Blockage of bile flow leads to thickening and buildup of bile causing an enlarged, red, and tense gallbladder. The gallbladder is initially sterile but often becomes infected by bacteria, predominantly ''E. coli'', ''Klebsiella'', ''Streptococcus'', and ''Clostridium'' species. Inflammation can spread to the outer covering of the gallbladder and surrounding structures such as the diaphragm, causing referred right shoulder pain. | Gallstones blocking the flow of bile account for 90% of cases of cholecystitis (acute calculous cholecystitis). Blockage of bile flow leads to thickening and buildup of bile causing an enlarged, red, and tense gallbladder. The gallbladder is initially sterile but often becomes infected by bacteria, predominantly ''E. coli'', ''Klebsiella'', ''Streptococcus'', and ''Clostridium'' species. Inflammation can spread to the outer covering of the gallbladder and surrounding structures such as the diaphragm, causing referred right shoulder pain. | ||
=== Acalculous cholecystitis | === Acalculous cholecystitis === | ||
In acalculous cholecystitis, no stone is in the biliary ducts. It accounts for 5–10% of all cases of cholecystitis and is associated with high morbidity and mortality rates. Acalculous cholecystitis is typically seen in people who are hospitalized and critically ill. Males are more likely to develop acute cholecystitis following surgery in the absence of trauma. It is associated with many causes including vasculitis, chemotherapy, major trauma or burns. | In acalculous cholecystitis, no stone is in the biliary ducts. It accounts for 5–10% of all cases of cholecystitis and is associated with high morbidity and mortality rates. Acalculous cholecystitis is typically seen in people who are hospitalized and critically ill. Males are more likely to develop acute cholecystitis following surgery in the absence of trauma. It is associated with many causes including vasculitis, chemotherapy, major trauma or burns. | ||
The presentation of acalculous cholecystitis is similar to calculous cholecystitis. Patients are more likely to have yellowing of the skin (jaundice) than in calculous cholecystitis. Ultrasonography or computed tomography often shows an immobile, enlarged gallbladder. Treatment involves immediate antibiotics and cholecystectomy within 24–72 hours. | The presentation of acalculous cholecystitis is similar to calculous cholecystitis. Patients are more likely to have yellowing of the skin (jaundice) than in calculous cholecystitis. Ultrasonography or computed tomography often shows an immobile, enlarged gallbladder. Treatment involves immediate antibiotics and cholecystectomy within 24–72 hours. | ||
=== Chronic cholecystitis | === Chronic cholecystitis === | ||
Chronic cholecystitis occurs after repeated episodes of acute cholecystitis and is almost always due to gallstones. Chronic cholecystitis may be asymptomatic, may present as a more severe case of acute cholecystitis, or may lead to a number of complications such as gangrene, perforation, or fistula formation. | Chronic cholecystitis occurs after repeated episodes of acute cholecystitis and is almost always due to gallstones. Chronic cholecystitis may be asymptomatic, may present as a more severe case of acute cholecystitis, or may lead to a number of complications such as gangrene, perforation, or fistula formation. | ||
Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis which mimics gallbladder cancer although it is not cancerous. It was first reported in the medical literature in 1976 by McCoy and colleagues. | Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis which mimics gallbladder cancer although it is not cancerous. It was first reported in the medical literature in 1976 by McCoy and colleagues. | ||
== | |||
=== [[Banerji protocols]] === | |||
Latest revision as of 21:25, 3 November 2023
Lyc
Clinic
- Cholecystitis is inflammation of the gallbladder.
- Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever.
- Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack.
- Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct.
- More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone. Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss.
- Occasionally, acute cholecystitis occurs as a result of vasculitis or chemotherapy, or during recovery from major trauma or burns.
- Cholecystitis is suspected based on symptoms and laboratory testing. Abdominal ultrasound is then typically used to confirm the diagnosis.
Signs / Symptoms
- Most people with gallstones do not have symptoms. However, when a gallstone temporarily lodges in the cystic duct, they experience biliary colic.
- Biliary colic is abdominal pain in the right upper quadrant or epigastric region. It is episodic, occurring after eating greasy or fatty foods, and leads to nausea and/or vomiting. People with cholecystitis most commonly have symptoms of biliary colic before developing cholecystitis. The pain becomes severe and constant in cholecystitis. Nausea is common and vomiting occurs in 75% of people with cholecystitis. In addition to abdominal pain, right shoulder pain can be present.
- On physical examination, an inflamed gallbladder is almost always tender to the touch and palpable (~25-50% of cases) in the midclavicular right lower rib margin. Additionally, a fever is common. A gallbladder with cholecystitis is almost always tender to touch. Because of the inflammation, its size can be felt from the outside of the body in 25–50% of people with cholecystitis. Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes severe pain (Murphy's sign). Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness.
Complications
A number of complications may occur from cholecystitis if not detected early or properly treated. Signs of complications include high fever, shock and jaundice. Complications include the following:
- Gangrene
- Gallbladder rupture
- Empyema
- Fistula formation and gallstone ileus
- Rokitansky-Aschoff sinuses
Causes
- Cholecystitis occurs when the gallbladder becomes inflamed.
- Gallstones are the most common cause of gallbladder inflammation but it can also occur due to blockage from a tumor or scarring of the bile duct.
Acute calculous cholecystitis
Gallstones blocking the flow of bile account for 90% of cases of cholecystitis (acute calculous cholecystitis). Blockage of bile flow leads to thickening and buildup of bile causing an enlarged, red, and tense gallbladder. The gallbladder is initially sterile but often becomes infected by bacteria, predominantly E. coli, Klebsiella, Streptococcus, and Clostridium species. Inflammation can spread to the outer covering of the gallbladder and surrounding structures such as the diaphragm, causing referred right shoulder pain.
Acalculous cholecystitis
In acalculous cholecystitis, no stone is in the biliary ducts. It accounts for 5–10% of all cases of cholecystitis and is associated with high morbidity and mortality rates. Acalculous cholecystitis is typically seen in people who are hospitalized and critically ill. Males are more likely to develop acute cholecystitis following surgery in the absence of trauma. It is associated with many causes including vasculitis, chemotherapy, major trauma or burns.
The presentation of acalculous cholecystitis is similar to calculous cholecystitis. Patients are more likely to have yellowing of the skin (jaundice) than in calculous cholecystitis. Ultrasonography or computed tomography often shows an immobile, enlarged gallbladder. Treatment involves immediate antibiotics and cholecystectomy within 24–72 hours.
Chronic cholecystitis
Chronic cholecystitis occurs after repeated episodes of acute cholecystitis and is almost always due to gallstones. Chronic cholecystitis may be asymptomatic, may present as a more severe case of acute cholecystitis, or may lead to a number of complications such as gangrene, perforation, or fistula formation.
Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis which mimics gallbladder cancer although it is not cancerous. It was first reported in the medical literature in 1976 by McCoy and colleagues.